Prasugrel versus Clopidogrel for Acute Coronary Syndromes without Revascularization
Why the study?
Does prasugrel reduce the composite of cardiovascular death, myocardial infarction, or stroke compared to clopidogrel in patients with unstable angina or NSTEMI who do not undergo revascularization?
Population
9,326 patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo…
Comparison
Prasugrel for up to 30 months. vs Clopidogrel (75 mg daily) for up to 30 months.
Design
RCT, randomized, double-blind
Follow-up
median 17 months
Authors
Discussion
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Implication
Prasugrel confers no ischemic benefit over clopidogrel in medically managed ACS; challenges extrapolation from PCI populations.
Structured PICO
Does prasugrel reduce the composite of cardiovascular death, myocardial infarction, or stroke compared to clopidogrel in patients with unstable angina or NSTEMI who do not undergo revascularization?
P
Population
9,326 patients (7,243 under 75 years; 2,083 aged 75 years or older) with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization, receiving aspirin.
I
Intervention
Prasugrel (10 mg daily for patients <75 years; 5 mg daily for patients ≥75 years) for up to 30 months.
C
Comparator
Clopidogrel (75 mg daily) for up to 30 months.
O
Outcome
Composite of death from cardiovascular causes, myocardial infarction, or stroke at median 17 months follow-up.composite
In patients with acute coronary syndromes managed medically without revascularization, prasugrel did not significantly reduce cardiovascular events compared to clopidogrel.
Cite This Study
Roe et al. (2012) studied this question.