Coronary Artery DiseaseOutcomes in Patients With ST-Segment Elevation Acute Myocardial Infarction Treated With Clopidogrel Versus Prasugrel (from the INFUSE-AMI Trial)
Section snippets
Methods
In the INFUSE-AMI trial, 452 patients with anterior STEMI (culprit lesion in proximal or mid left anterior descending artery and TIMI flow grade 0 to 2) and anticipated symptom onset-to-reperfusion time of <5 hours underwent primary PCI with bivalirudin anticoagulation. All patients received aspirin and either clopidogrel or prasugrel at investigator discretion. They were randomized in a 2 × 2 factorial design to abciximab delivered locally at the site of the infarct lesion by means of the
Results
Prasugrel and clopidogrel were administered to 155 patients (34.3%) and 297 patients (65.7%), respectively. Baseline characteristics between the groups were well matched (Table 1), except prasugrel-treated patients were younger, had no previous stroke, had higher left ventricular ejection fraction, and greater use of drug-eluting stents. The results of primary PCI and 30-day IS are listed in Table 2. Prasugrel-treated patients had higher rates of procedural success (94% vs 89%, p = 0.03), TIMI
Discussion
In the INFUSE-AMI trial, use of prasugrel rather than clopidogrel in patients with large anterior myocardial infarction treated with bivalirudin anticoagulation was associated with a reduction in all-cause and cardiovascular death, in new onset of heart failure and in MACE, with nonsignificantly different rates of major bleeding. The number of patients in whom stent thrombosis developed was not sufficient to determine whether prasugrel was of benefit in reducing thrombotic events, although it
Disclosures
Drs. Mehran, Gibson and Stone served as consultants for Atrium Medical and The Medicine Company. The other authors have no disclosures.
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