Citation
Clemmensen, Peter, et al. "MULTInational Non-interventional Study of Patients With ST-segment Elevation Myocardial Infarction Treated With PRimary Angioplasty and Concomitant Use of Upstream Antiplatelet Therapy With Prasugrel or Clopidogrel--the European MULTIPRAC Registry." European Heart Journal. Acute Cardiovascular Care, vol. 4, no. 3, 2015, pp. 220-9.
Clemmensen P, Grieco N, Ince H, et al. MULTInational non-interventional study of patients with ST-segment elevation myocardial infarction treated with PRimary Angioplasty and Concomitant use of upstream antiplatelet therapy with prasugrel or clopidogrel--the European MULTIPRAC Registry. Eur Heart J Acute Cardiovasc Care. 2015;4(3):220-9.
Clemmensen, P., Grieco, N., Ince, H., Danchin, N., Goedicke, J., Ramos, Y., Schmitt, J., & Goldstein, P. (2015). MULTInational non-interventional study of patients with ST-segment elevation myocardial infarction treated with PRimary Angioplasty and Concomitant use of upstream antiplatelet therapy with prasugrel or clopidogrel--the European MULTIPRAC Registry. European Heart Journal. Acute Cardiovascular Care, 4(3), 220-9. https://doi.org/10.1177/2048872614547449
Clemmensen P, et al. MULTInational Non-interventional Study of Patients With ST-segment Elevation Myocardial Infarction Treated With PRimary Angioplasty and Concomitant Use of Upstream Antiplatelet Therapy With Prasugrel or Clopidogrel--the European MULTIPRAC Registry. Eur Heart J Acute Cardiovasc Care. 2015;4(3):220-9. PubMed PMID: 25182465.
TY - JOUR
T1 - MULTInational non-interventional study of patients with ST-segment elevation myocardial infarction treated with PRimary Angioplasty and Concomitant use of upstream antiplatelet therapy with prasugrel or clopidogrel--the European MULTIPRAC Registry.
AU - Clemmensen,Peter,
AU - Grieco,Niccolò,
AU - Ince,Hüseyin,
AU - Danchin,Nicolas,
AU - Goedicke,Jochen,
AU - Ramos,Yvonne,
AU - Schmitt,Josef,
AU - Goldstein,Patrick,
AU - ,,
Y1 - 2014/09/02/
PY - 2014/02/25/received
PY - 2014/07/25/accepted
PY - 2014/9/4/entrez
PY - 2014/9/4/pubmed
PY - 2016/2/11/medline
KW - Acute coronary syndrome (ACS)
KW - European
KW - P2Y12 inhibitor
KW - ST-segment myocardial infarction (STEMI)
KW - drug therapy
KW - dual antiplatelet therapy (DAPT)
KW - myocardial infarction
KW - observational study
KW - oral antiplatelet
KW - pre-hospital
KW - pre-treatment
KW - primary angioplasty
KW - primary percutaneous coronary intervention
KW - registry
KW - thienoypridine
KW - upstream treatment
SP - 220
EP - 9
JF - European heart journal. Acute cardiovascular care
JO - Eur Heart J Acute Cardiovasc Care
VL - 4
IS - 3
N2 - AIMS: Early initiation of dual antiplatelet therapy (DAPT) is guideline-recommended. MULTIPRAC was conducted to gain insights into the use patterns and outcomes of pre-hospital DAPT initiation with prasugrel or clopidogrel. METHODS AND RESULTS: MULTIPRAC is a multinational, multicentre, prospective registry enrolling 2053 ST-segment elevation myocardial infarction (STEMI) patients. Patients were grouped according to adherence to the initially prescribed thienopyridine. Pre-hospital use of prasugrel increased from 12.5% to 67.1% at study end. Prasugrel compared to clopidogrel-initiated patients more often adhered to the medication through discharge (87% vs. 38%) whereas 49% of the clopidogrel-initiated patients were switched to prasugrel. Patients who continued on clopidogrel were substantially older. In-hospital mortality was 0.5%, early stent thrombosis 0.1%. The major adverse cardiac events (MACE) rate was 1.6% in prasugrel-treated vs. 2.3% in clopidogrel-treated patients (adjusted OR 0.749, 95% CI [0.285-1.968]). Non-coronary artery bypass graft (non-CABG) bleeding occurred in 4.1% of prasugrel-treated vs. 6.1% of clopidogrel-treated patients (adjusted OR 0.686 [0.349-1.349]). Pre-percutaneous coronary intervention (PCI) TIMI flow 2-3 was seen in 38.7% treated with prasugrel vs. 35.6% with clopidogrel (adjusted OR 1.170 [0.863-1.585]). Post PCI ST-segment resolution ⩾50%, was 71.6% with prasugrel vs. 65.0% with clopidogrel (adjusted OR 1.543 [1.138-2.093], p=0.0052). CONCLUSIONS: MULTIPRAC demonstrated a steady increase in prasugrel use over time without an increase in bleeding rates compared to clopidogrel. ST resolution was more pronounced with prasugrel. Switching between antiplatelet drugs occurs frequently. The low rates of MACE, in-hospital mortality and bleeding, suggests that pre-hospital loading with thienopyridines is confined to low-risk patients. These results emphasize the need for more randomized pre-hospital studies and should be seen in the context of upcoming randomized trials involving pre-hospital antiplatelet therapies.
SN - 2048-8734
UR - https://www.unboundmedicine.com/medline/citation/25182465/MULTInational_non_interventional_study_of_patients_with_ST_segment_elevation_myocardial_infarction_treated_with_PRimary_Angioplasty_and_Concomitant_use_of_upstream_antiplatelet_therapy_with_prasugrel_or_clopidogrel__the_European_MULTIPRAC_Registry_
L2 - https://journals.sagepub.com/doi/10.1177/2048872614547449?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed
DB - PRIME
DP - Unbound Medicine
ER -