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Effect of prasugrel versus clopidogrel on outcomes among patients with acute coronary syndrome undergoing percutaneous coronary intervention without stent implantation: a TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibitioN with prasugrel (TRITON)-Thrombolysis in Myocardial Infarction (TIMI) 38 substudy.
Am Heart J 2009; 158(3):e21-6AH

Abstract

BACKGROUND

Prasugrel led to a significant reduction in ischemic cardiovascular events among patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) with stent implantation compared to clopidogrel. Whether this benefit extends to patients undergoing PCI without stent implantation is unknown.

METHODS

In TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibitioN with prasugrel (TRITON)-Thrombolysis in Myocardial Infarction (TIMI) 38, patients (n = 13 608) undergoing PCI for ACS were randomized to aspirin plus clopidogrel or prasugrel. This postrandomization analysis of a prespecified subgroup was restricted to patients who underwent PCI without stent implantation (n = 569).

RESULTS

Patients who underwent PCI without stent implantation were older and had a higher incidence of hypertension, diabetes, prior myocardial infarction (MI), prior coronary artery bypass (CABG) surgery, and renal dysfunction than patients who underwent stent implantation. In the group that did not undergo stent implantation, baseline characteristics were similar between patients receiving clopidogrel and prasugrel. The composite of cardiovascular death, nonfatal MI, and nonfatal stroke occurred in 14.2% of patients receiving prasugrel and 17.1% of patients receiving clopidogrel (HR 0.82, P = .27). There were significant reductions favoring prasugrel in the rates of urgent target vessel revascularization (TVR; HR 0.46, P = .040) and any TVR (HR 0.40, P = .009) and a trend toward a reduction in the incidence of nonfatal MI (HR 0.65, P = .11). CABG-related TIMI major bleeding was more frequent among patients receiving prasugrel. There were no significant interactions between treatment and PCI type.

CONCLUSION

Among ACS patients who underwent PCI without stent implantation, prasugrel therapy tended to reduce clinical ischemic events and to increase bleeding events to a similar magnitude as among patients who received stents.

Authors+Show Affiliations

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19699846

Citation

Pride, Yuri B., et al. "Effect of Prasugrel Versus Clopidogrel On Outcomes Among Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Without Stent Implantation: a TRial to Assess Improvement in Therapeutic Outcomes By Optimizing Platelet inhibitioN With Prasugrel (TRITON)-Thrombolysis in Myocardial Infarction (TIMI) 38 Substudy." American Heart Journal, vol. 158, no. 3, 2009, pp. e21-6.
Pride YB, Wiviott SD, Buros JL, et al. Effect of prasugrel versus clopidogrel on outcomes among patients with acute coronary syndrome undergoing percutaneous coronary intervention without stent implantation: a TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibitioN with prasugrel (TRITON)-Thrombolysis in Myocardial Infarction (TIMI) 38 substudy. Am Heart J. 2009;158(3):e21-6.
Pride, Y. B., Wiviott, S. D., Buros, J. L., Zorkun, C., Tariq, M. U., Antman, E. M., ... Gibson, C. M. (2009). Effect of prasugrel versus clopidogrel on outcomes among patients with acute coronary syndrome undergoing percutaneous coronary intervention without stent implantation: a TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibitioN with prasugrel (TRITON)-Thrombolysis in Myocardial Infarction (TIMI) 38 substudy. American Heart Journal, 158(3), pp. e21-6. doi:10.1016/j.ahj.2009.06.021.
Pride YB, et al. Effect of Prasugrel Versus Clopidogrel On Outcomes Among Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Without Stent Implantation: a TRial to Assess Improvement in Therapeutic Outcomes By Optimizing Platelet inhibitioN With Prasugrel (TRITON)-Thrombolysis in Myocardial Infarction (TIMI) 38 Substudy. Am Heart J. 2009;158(3):e21-6. PubMed PMID: 19699846.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of prasugrel versus clopidogrel on outcomes among patients with acute coronary syndrome undergoing percutaneous coronary intervention without stent implantation: a TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibitioN with prasugrel (TRITON)-Thrombolysis in Myocardial Infarction (TIMI) 38 substudy. AU - Pride,Yuri B, AU - Wiviott,Stephen D, AU - Buros,Jacqueline L, AU - Zorkun,Cafer, AU - Tariq,M Umer, AU - Antman,Elliott M, AU - Braunwald,Eugene, AU - Gibson,C Michael, AU - ,, PY - 2009/05/01/received PY - 2009/06/20/accepted PY - 2009/8/25/entrez PY - 2009/8/25/pubmed PY - 2009/10/9/medline SP - e21 EP - 6 JF - American heart journal JO - Am. Heart J. VL - 158 IS - 3 N2 - BACKGROUND: Prasugrel led to a significant reduction in ischemic cardiovascular events among patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) with stent implantation compared to clopidogrel. Whether this benefit extends to patients undergoing PCI without stent implantation is unknown. METHODS: In TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibitioN with prasugrel (TRITON)-Thrombolysis in Myocardial Infarction (TIMI) 38, patients (n = 13 608) undergoing PCI for ACS were randomized to aspirin plus clopidogrel or prasugrel. This postrandomization analysis of a prespecified subgroup was restricted to patients who underwent PCI without stent implantation (n = 569). RESULTS: Patients who underwent PCI without stent implantation were older and had a higher incidence of hypertension, diabetes, prior myocardial infarction (MI), prior coronary artery bypass (CABG) surgery, and renal dysfunction than patients who underwent stent implantation. In the group that did not undergo stent implantation, baseline characteristics were similar between patients receiving clopidogrel and prasugrel. The composite of cardiovascular death, nonfatal MI, and nonfatal stroke occurred in 14.2% of patients receiving prasugrel and 17.1% of patients receiving clopidogrel (HR 0.82, P = .27). There were significant reductions favoring prasugrel in the rates of urgent target vessel revascularization (TVR; HR 0.46, P = .040) and any TVR (HR 0.40, P = .009) and a trend toward a reduction in the incidence of nonfatal MI (HR 0.65, P = .11). CABG-related TIMI major bleeding was more frequent among patients receiving prasugrel. There were no significant interactions between treatment and PCI type. CONCLUSION: Among ACS patients who underwent PCI without stent implantation, prasugrel therapy tended to reduce clinical ischemic events and to increase bleeding events to a similar magnitude as among patients who received stents. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/19699846/Effect_of_prasugrel_versus_clopidogrel_on_outcomes_among_patients_with_acute_coronary_syndrome_undergoing_percutaneous_coronary_intervention_without_stent_implantation:_a_TRial_to_assess_Improvement_in_Therapeutic_Outcomes_by_optimizing_platelet_inhibitioN_with_prasugrel__TRITON__Thrombolysis_in_Myocardial_Infarction__TIMI__38_substudy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00476-1 DB - PRIME DP - Unbound Medicine ER -