Prasugrel Superior to Clopidogrel for STEMI Patients Undergoing PCI
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- The study compared the effects of prasugrel versus clopidogrel in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). - 3534 participants presenting with STEMI were randomly assigned to receive either prasugrel or clopidogrel and followed for up to 15 months. - Prasugrel was found to be superior to clopidogrel in preventing cardiovascular events such as death, heart attack, and stroke, without increasing the risk of bleeding.
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Prasugrel Superior to Clopidogrel for STEMI Patients Undergoing PCI
- 1. Prof Gilles Montalescot MD a , Stephen D Wiviott MD b , Eugene Braunwald MD b , Sabina A Murphy MPH b , C Michael Gibson MD b , Carolyn H McCabe BS b , Elliott M Antman MD b , for the TRITON-TIMI 38 investigators The Lancet, Volume 373, Issue 9665 , Pages 723 - 731, 28 February 2009
- 4. Montalescot et al. The lancet 2009 * 2 patients were missing data for primary or secondary All ACS /PCI patients N=13608 UA/NSTEMI patients N=10074 STEMI patients N=3534 Primary PCI N=2438 (69%) Secondary PCI N=1094 (31%)* Clopidogrel N=1235 Prasugrel N=1203 Clopidogrel N=530 Prasugrel N=564
- 6. Montalescot et al. Variable Primary PCI (%) Secondary PCI (%) p Age (years) 59 58 0.01 History of diabetes 16.8 24.1 0.001 Prior CABG 1.9 3.2 0.02 Multivessel PCI 6.5 11.0 0.001 GPIIb/IIIa inhibitor 64.5 59.8 0.01 Creatinine clear. < 60mL/min 11.4 8.8 0.02
- 9. End point Clopidogrel(%) Prasugrel(%) Hazard ratio (95% CI) Cardiovascular death, nonfatal MI, and nonfatal stroke 9.5 6.5 0.68 (0.54-0.87) Cardiovascular death, nonfatal MI, and TVR 8.8 6.7 0.75 (0.59-0.96) Cardiovascular death and MI 8.8 6.2 0.70 (0.55-0.90) Cardiovascular death 2.4 1.4 0.61 (0.37-1.00)
- 10. End point MI (CLOPIDOGREL) 7.0 (PRASUGREL) 4.9 0.70 (0.53-0.92) TLR 1.9 1.3 0.66 (0.39-1.14) Stroke 0.9 0.4 0.43 (0.18-1.06) Stent thrombosis 2.4 1.2 0.49 (0.28-0.84) TIMI major bleeding unrelated to CABG surgery 1.3 1.0 0.74 (0.39-1.38)
- 11. End point Clopidogrel(%) Prasugrel(%) Hazard ratio (95% CI) Cardiovascular death, nonfatal MI, and nonfatal stroke 12.4 10.0 0.79 (0.65-0.97) Cardiovascular death, nonfatal MI, and TVR 12.0 9.6 0.79 (0.65-0.97) Cardiovascular death and MI 11.5 8.8 0.75 (0.61-0.93) Cardiovascular death 3.4 2.4 0.74 (0.50-1.09)
- 12. Montalescot et al. p=0.02 NNT=42 Death / non-fatal MI / non-fatal stroke or major non-CABG bleeding Death / MI /stroke/ major bleeding (CABG and non-CABG) p=0.04 NNT=45 Clopidogrel Prasugrel Proportion of population (%)