Double-Blind, Randomized, Prospective Comparison of Loading Doses of 600 mg Clopidogrel Versus 60 mg Prasugrel in Patients With Acute ST-Segment Elevation Myocardial Infarction Scheduled for Primary Percutaneous Intervention: The ETAMI Trial (Early Thienopyridine treatment to improve primary PCI in Patients with Acute Myocardial Infarction)

doi:10.1016/j.jcin.2014.09.007

JACC: Cardiovascular Interventions

Volume 8, Issue 1, Part B, January 2015, Pages 147-154

https://doi.org/10.1016/j.jcin.2014.09.007 Get rights and content

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Abstract

Objectives

This study compared the timing of onset of antiplatelet action after treatment with clopidogrel and prasugrel at first medical contact in patients with ST-segment elevation myocardial infarction (STEMI) scheduled for primary percutaneous coronary intervention (PPCI).

Background

Little is known about the timing of onset of antiplatelet action after a pre-percutaneous coronary intervention (PCI) loading dose of clopidogrel or prasugrel in patients with STEMI.

Methods

This double-blind, prospective study randomized 62 patients with STEMI scheduled for PPCI in the ambulance or the emergency department to 60 mg prasugrel (n = 31) or 600 mg clopidogrel (n = 31). The primary endpoint was the platelet reactivity index (PRI) measured with the vasodilator-stimulated phosphoprotein assay 2 h after intake of the study medication. Secondary endpoints were PRI after 4 h, TIMI (Thrombolysis In Myocardial Infarction) patency of the infarct-related artery before and after PCI, and clinical events until day 30.

Results

The PRI after 2 h (50.4 ± 32.7% vs. 66.3 ± 22.2%; p = 0.035) and after 4 h (39.1 ± 27.5% vs. 54.5 ± 49.3%; p = 0.038) were significantly lower with prasugrel compared with clopidogrel. In addition, the rate of patients with a PRI <50% tended to be higher with prasugrel compared with clopidogrel after 2 h (46.7% vs. 28.6%; p = 0.15) and after 4 h (63.0% vs. 38.9%; p = 0.06). There were no significant differences in TIMI 2/3 patency before PCI (39.2% vs. 31.0%; p = 0.43) and TIMI 3 patency after PCI (88.5% vs. 89.3%; p = 0.92).

Conclusions

The pre-PCI administration of prasugrel in patients with STEMI undergoing PPCI was associated with a significant faster platelet inhibition compared with clopidogrel. Therefore, prasugrel should be preferred to clopidogrel in this setting. (ETAMI-Study: Early Thienopyridine Treatment to Improve Primary PCI in Patients With Acute Myocardial Infarction; NCT01327534)

Key Words

ADP receptor inhibitors

clopidogrel

inhibition of platelet aggregation

prasugrel

primary percutaneous coronary intervention

Abbreviations and Acronyms

ADP

adenosine diphosphate

glycoprotein

PCI

percutaneous coronary intervention

PPCI

primary percutaneous coronary intervention

PRI

platelet reactivity index

STEMI

ST-segment elevation myocardial infarction

TIMI

Thrombolysis In Myocardial Infarction

Cited by (0)

: This study was funded by Daiichi Sankyo and the Stiftung Institut für Herzinfarktforschung Ludwigshafen. Dr. Zeymer has received research funding from Eli Lilly, Daiichi Sankyo, and Sanofi; has received speakers honoraria from AstraZeneca, Daiichi Sankyo, Eli Lilly, and Sanofi; and has served on the advisory board of AstraZeneca, Daiichi Sankyo, Lilly, and The Medicines Company. Dr. Arntz has received speakers honoraria from Daiichi Sankyo and Eli Lilly. Dr. Thiele has received research funding from Eli Lilly; and has received speakers honoraria from Eli Lilly, Daiichi Sankyo, AstraZeneca, and Boehringer Ingelheim. Dr. Montalescot has received consulting fees from Bayer, Boehringer Ingelheim, Europa, GlaxoSmithKline, Iroko Cardio International, Lead-Up, Novartis, Springer, TIMI Group, WebMD, and Wolters; and has received consulting fees and grant support from Bristol-Myers Squibb, AstraZeneca, Biotronik, Eli Lilly, the Medicines Company, Medtronic, Menarini, Roche, and Sanofi-Aventis. Dr. Zahn has received speakers honoraria from Daiichi Sankyo and Eli Lilly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.