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Int J Cardiol. 2015 Apr 1;184:122-7. doi: 10.1016/j.ijcard.2015.01.047. Epub 2015 Jan 26.

Use, efficacy and safety of prasugrel in patients with ST segment elevation myocardial infarction scheduled for primary percutaneous coronary intervention in clinical practice. Results of the prospective ATACS-registry.

Author information

1
Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Germany. Electronic address: Uwe.Zeymer@t-online.de.
2
Institut für Herzinfarktforschung Ludwigshafen, Germany.
3
Zentrallinik Bad Berka, Germany.
4
Stiftungsklinikum Mittelrhein, Koblenz, Germany.
5
Universitätsklinikum Ulm, Ulm, Germany.
6
Vivantes Klinikum am Urban, Berlin, Germany.
7
Klinikum Leverkusen, Leverkusen, Germany.
8
Ostalb-Klinikum Aalen, Aalen, Germany.
9
Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
10
Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Germany.
11
Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany.

Abstract

BACKGROUND:

Prasugrel compared to clopidogrel has been shown to improve outcome in patients with ST elevation myocardial infarction (STEMI) in the TRITON-TIMI 38 trial. Little is known about the use, efficacy and safety of prasugrel in patients with STEMI in clinical practice.

METHODS:

We conducted a prospective registry including patients with STEMI scheduled for primary percutaneous coronary intervention (PCI). Between October 2009 and February 2013 a total of 3291 patients with STEMI receiving a loading dose of either clopidogrel or prasugrel were included in this analysis.

RESULTS:

Prasugrel was predominantly used in patients <75 years, body weight >60 kg and those without prior stroke. In-hospital mortality was numerically lower in the prasugrel group (1.7% vs. 4.4%), as well as non-fatal reinfarction (0.2% vs. 0.5%), non-fatal stroke (0.1% vs. 0.3%) and major cardiac and cerebrovascular events (MACCE) (2.1% vs. 5.2%), while there was no difference in major bleeding complications (0.8% vs. 0.9%). In the multivariate analysis the MACCE-rate tended to be lower in prasugrel treated patients (odds ratio 0.71, 95% confidence intervals 0.42-1.08) but bleeding-rates tended to be higher.

CONCLUSIONS:

In this real life experience in patients with STEMI scheduled for primary PCI, prasugrel was almost exclusively used in the label-recommended patient population and tended to be more effective but associated with more bleedings compared to clopidogrel. These results support the findings in the STEMI population in the randomized TRITON-TIMI 38 study.

KEYWORDS:

Antiplatelet therapy; Clopidogrel; Percutaneous coronary intervention; Prasugrel; ST elevation myocardial infarction

PMID:
25703419
DOI:
10.1016/j.ijcard.2015.01.047
[Indexed for MEDLINE]

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