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Erschienen in: Journal of Thrombosis and Thrombolysis 1/2019

28.03.2019 | Clopidogrel

Associations between use of prasugrel vs clopidogrel and outcomes by type of acute coronary syndrome: an analysis from the PROMETHEUS registry

verfasst von: Zhen Ge, Usman Baber, Bimmer E. Claessen, Jaya Chandrasekhar, Rishi Chandiramani, Shawn X. Li, Samantha Sartori, Annapoorna S. Kini, Sunil V. Rao, Sandra Weiss, Timothy D. Henry, Samir Kapadia, Brent Muhlestein, Craig Strauss, Catalin Toma, Anthony DeFranco, Mark B. Effron, Stuart Keller, Brian A. Baker, Stuart Pocock, George Dangas, Roxana Mehran

Erschienen in: Journal of Thrombosis and Thrombolysis | Ausgabe 1/2019

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Abstract

We sought to investigate the utilization of prasugrel and its association with outcomes relative to clopidogrel in three typical subgroups of ACS in a real-world setting. Prasugrel is superior to clopidogrel for reducing risk of ischemic events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), but is associated with an increased risk of bleeding complications. PROMETHEUS was a retrospective multicenter observational study of 19,913 ACS patients undergoing PCI from 8 centers in the United States between 2010 and 2013. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause mortality, myocardial infarction, stroke or unplanned revascularization. The study cohort included 3285 (16.5%) patients with ST-segment elevation myocardial infarction (STEMI), 5412 (27.2%) patients with NSTEMI and 11,216 (56.3%) patients with unstable angina (UA). The frequency of prasugrel use at discharge was highest in STEMI and lowest in UA patients, 27.3% versus 22.2% versus 18.9% (p < 0.001). Use of prasugrel vs clopidogrel was associated with a lower rate of MACE in STEMI, NSTEMI, or UA at 1 year, but the differences were attenuated for all groups except for patients with UA (adjusted HR 0.81, 95% CI 0.69–0.94, p = 0.006) after propensity adjusted analysis. After adjustment, there was no difference in bleeding risk between prasugrel and clopidogrel for all groups at 1 year. STEMI patients were more likely to receive prasugrel compared to NSTEMI and UA patients. Prasugrel was associated with reduced adverse outcomes compared with clopidogrel in unadjusted analyses, findings that were largely attenuated upon adjustment and suggest preferential use of prasugrel in low vs high risk patients.
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Literatur
1.
Zurück zum Zitat Wiviott SD, Braunwald E, McCabe CH et al (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357:2001–2015CrossRefPubMed Wiviott SD, Braunwald E, McCabe CH et al (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357:2001–2015CrossRefPubMed
2.
Zurück zum Zitat De Servi S, Goedicke J, Schirmer A, Widimsky P (2014) Clinical outcomes for prasugrel versus clopidogrel in patients with unstable angina or non-ST-elevation myocardial infarction: an analysis from the TRITON-TIMI 38 trial. Eur Heart J Acute Cardiovasc Care 3:363–372CrossRefPubMed De Servi S, Goedicke J, Schirmer A, Widimsky P (2014) Clinical outcomes for prasugrel versus clopidogrel in patients with unstable angina or non-ST-elevation myocardial infarction: an analysis from the TRITON-TIMI 38 trial. Eur Heart J Acute Cardiovasc Care 3:363–372CrossRefPubMed
3.
Zurück zum Zitat Montalescot G, Wiviott SD, Braunwald E et al (2009) Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 373:723–731CrossRefPubMed Montalescot G, Wiviott SD, Braunwald E et al (2009) Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 373:723–731CrossRefPubMed
4.
Zurück zum Zitat Federspiel JJ, Anstrom KJ, Xian Y et al (2016) Comparing inverse probability of treatment weighting and instrumental variable methods for the evaluation of adenosine diphosphate receptor inhibitors after percutaneous coronary intervention. JAMA Cardiol 1:655–665CrossRefPubMed Federspiel JJ, Anstrom KJ, Xian Y et al (2016) Comparing inverse probability of treatment weighting and instrumental variable methods for the evaluation of adenosine diphosphate receptor inhibitors after percutaneous coronary intervention. JAMA Cardiol 1:655–665CrossRefPubMed
5.
Zurück zum Zitat Zeymer U, Hochadel M, Lauer B et al (2015) 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. Int J Cardiol 184:122–127CrossRefPubMed Zeymer U, Hochadel M, Lauer B et al (2015) 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. Int J Cardiol 184:122–127CrossRefPubMed
6.
Zurück zum Zitat Bacquelin R, Oger E, Filippi E et al (2016) Safety of prasugrel in real-world patients with ST-segment elevation myocardial infarction: 1-year results from a prospective observational study (Bleeding and Myocardial Infarction Study). Arch Cardiovasc Dis 109:31–38CrossRefPubMed Bacquelin R, Oger E, Filippi E et al (2016) Safety of prasugrel in real-world patients with ST-segment elevation myocardial infarction: 1-year results from a prospective observational study (Bleeding and Myocardial Infarction Study). Arch Cardiovasc Dis 109:31–38CrossRefPubMed
7.
Zurück zum Zitat Lattuca B, Fabbro-Peray P, Leclercq F et al (2016) One-year incidence and clinical impact of bleeding events in patients treated with prasugrel or clopidogrel after ST-segment elevation myocardial infarction. Arch Cardiovasc Dis 109:337–347CrossRefPubMed Lattuca B, Fabbro-Peray P, Leclercq F et al (2016) One-year incidence and clinical impact of bleeding events in patients treated with prasugrel or clopidogrel after ST-segment elevation myocardial infarction. Arch Cardiovasc Dis 109:337–347CrossRefPubMed
8.
Zurück zum Zitat Baber U, Sartori S, Aquino M et al (2017) Use of prasugrel vs clopidogrel and outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention in contemporary clinical practice: Results from the PROMETHEUS study. Am Heart J 188:73–81CrossRefPubMed Baber U, Sartori S, Aquino M et al (2017) Use of prasugrel vs clopidogrel and outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention in contemporary clinical practice: Results from the PROMETHEUS study. Am Heart J 188:73–81CrossRefPubMed
9.
Zurück zum Zitat Kushner FG, Hand M, Smith SC Jr et al (2009) 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 120:2271–2306CrossRefPubMed Kushner FG, Hand M, Smith SC Jr et al (2009) 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 120:2271–2306CrossRefPubMed
10.
Zurück zum Zitat Anderson JL, Adams CD, Antman EM, /Non ST-Elevation (2007) et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina. Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation 116:e148–e304PubMed Anderson JL, Adams CD, Antman EM, /Non ST-Elevation (2007) et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina. Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation 116:e148–e304PubMed
11.
Zurück zum Zitat Thygesen K, Alpert JS, Jaffe AS et al (2012) Third universal definition of myocardial infarction. Circulation 126:2020–2035CrossRefPubMed Thygesen K, Alpert JS, Jaffe AS et al (2012) Third universal definition of myocardial infarction. Circulation 126:2020–2035CrossRefPubMed
12.
Zurück zum Zitat Cutlip DE, Windecker S, Mehran R et al (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115:2344–2351CrossRef Cutlip DE, Windecker S, Mehran R et al (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115:2344–2351CrossRef
13.
Zurück zum Zitat Khayata M, Gabra JN, Nasser MF, Litman GI, Bhakta S, Raina R (2017) Comparison of clopidogrel with prasugrel and ticagrelor in patients with acute coronary syndrome: clinical outcomes from the national cardiovascular database ACTION registry. Cardiol Res 8:105–110CrossRefPubMedPubMedCentral Khayata M, Gabra JN, Nasser MF, Litman GI, Bhakta S, Raina R (2017) Comparison of clopidogrel with prasugrel and ticagrelor in patients with acute coronary syndrome: clinical outcomes from the national cardiovascular database ACTION registry. Cardiol Res 8:105–110CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Hirsch A, Verouden NJ, Koch KT et al (2009) Comparison of long-term mortality after percutaneous coronary intervention in patients treated for acute ST-elevation myocardial infarction versus those with unstable and stable angina pectoris. Am J Cardiol 104:333–337CrossRefPubMed Hirsch A, Verouden NJ, Koch KT et al (2009) Comparison of long-term mortality after percutaneous coronary intervention in patients treated for acute ST-elevation myocardial infarction versus those with unstable and stable angina pectoris. Am J Cardiol 104:333–337CrossRefPubMed
15.
Zurück zum Zitat Polonski L, Gasior M, Gierlotka M et al (2011) A comparison of ST elevation versus non-ST elevation myocardial infarction outcomes in a large registry database: are non-ST myocardial infarctions associated with worse long-term prognoses? Int J Cardiol 152:70–77CrossRefPubMed Polonski L, Gasior M, Gierlotka M et al (2011) A comparison of ST elevation versus non-ST elevation myocardial infarction outcomes in a large registry database: are non-ST myocardial infarctions associated with worse long-term prognoses? Int J Cardiol 152:70–77CrossRefPubMed
16.
Zurück zum Zitat Rafique AM, Nayyar P, Wang TY et al (2016) Optimal P2Y12 inhibitor in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a network meta-analysis. JACC Cardiovasc Interv 9:1036–1046CrossRefPubMed Rafique AM, Nayyar P, Wang TY et al (2016) Optimal P2Y12 inhibitor in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a network meta-analysis. JACC Cardiovasc Interv 9:1036–1046CrossRefPubMed
17.
Zurück zum Zitat Wallentin L, Becker RC, Budaj A et al (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 361:1045–1057CrossRefPubMed Wallentin L, Becker RC, Budaj A et al (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 361:1045–1057CrossRefPubMed
18.
Zurück zum Zitat Kim K, Lee TA, Touchette DR, DiDomenico RJ, Ardati AK, Walton SM (2017) Contemporary trends in oral antiplatelet agent use in patients treated with percutaneous coronary intervention for acute coronary syndrome. J Manag Care Spec Pharm 23:57–63PubMed Kim K, Lee TA, Touchette DR, DiDomenico RJ, Ardati AK, Walton SM (2017) Contemporary trends in oral antiplatelet agent use in patients treated with percutaneous coronary intervention for acute coronary syndrome. J Manag Care Spec Pharm 23:57–63PubMed
19.
Zurück zum Zitat Karve AM, Seth M, Sharma M et al (2015) Contemporary use of ticagrelor in interventional practice (from blue cross blue shield of Michigan cardiovascular consortium). Am J Cardiol 115:1502–1506CrossRefPubMed Karve AM, Seth M, Sharma M et al (2015) Contemporary use of ticagrelor in interventional practice (from blue cross blue shield of Michigan cardiovascular consortium). Am J Cardiol 115:1502–1506CrossRefPubMed
20.
Zurück zum Zitat Sherwood MW, Wiviott SD, Peng SA et al. Early clopidogrel versus prasugrel use among contemporary STEMI and NSTEMI patients in the US: insights from the National Cardiovascular Data Registry. J Am Heart Assoc. 2014;3: e000849 Sherwood MW, Wiviott SD, Peng SA et al. Early clopidogrel versus prasugrel use among contemporary STEMI and NSTEMI patients in the US: insights from the National Cardiovascular Data Registry. J Am Heart Assoc. 2014;3: e000849
21.
Zurück zum Zitat Roe MT, Armstrong PW, Fox KA et al (2012) Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med 367:1297–1309CrossRefPubMed Roe MT, Armstrong PW, Fox KA et al (2012) Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med 367:1297–1309CrossRefPubMed
Metadaten
Titel
Associations between use of prasugrel vs clopidogrel and outcomes by type of acute coronary syndrome: an analysis from the PROMETHEUS registry
verfasst von
Zhen Ge
Usman Baber
Bimmer E. Claessen
Jaya Chandrasekhar
Rishi Chandiramani
Shawn X. Li
Samantha Sartori
Annapoorna S. Kini
Sunil V. Rao
Sandra Weiss
Timothy D. Henry
Samir Kapadia
Brent Muhlestein
Craig Strauss
Catalin Toma
Anthony DeFranco
Mark B. Effron
Stuart Keller
Brian A. Baker
Stuart Pocock
George Dangas
Roxana Mehran
Publikationsdatum
28.03.2019
Verlag
Springer US
Erschienen in
Journal of Thrombosis and Thrombolysis / Ausgabe 1/2019
Print ISSN: 0929-5305
Elektronische ISSN: 1573-742X
DOI
https://doi.org/10.1007/s11239-019-01842-9

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