Key result
Prasugrel linked to ~30% fewer major events at discharge vs clopidogrel in ACS patients undergoing PCI.
Why the study?
Does prasugrel reduce the composite of death, recurrent infarction, and stroke at hospital discharge compared to clopidogrel in ACS patients undergoing PCI?
Cohort (n=7,621)
Yes
Does prasugrel reduce the composite of death, recurrent infarction, and stroke at hospital discharge compared to clopidogrel in ACS patients undergoing PCI?
Absolute Event Rate: 3% vs 4.3%
p-value: p=0.022
In a real-world Swiss registry of ACS patients undergoing PCI, prasugrel was associated with a lower rate of in-hospital death, recurrent infarction, and stroke compared to clopidogrel, albeit with an increase in bleeding events.
May support prasugrel preference in ACS-PCI; leaves open need for randomized confirmation before practice change.
OBJECTIVE: The purpose of this study was to investigate outcomes of patients treated with prasugrel or clopidogrel after percutaneous coronary intervention (PCI) in a nationwide acute coronary syndrome (ACS) registry. BACKGROUND: Prasugrel was found to be superior to clopidogrel in a randomized trial of ACS patients undergoing PCI. However, little is known about its efficacy in everyday practice. METHODS: All ACS patients enrolled in the Acute Myocardial Infarction in Switzerland (AMIS)-Plus registry undergoing PCI and being treated with a thienopyridine P2Y12 inhibitor between January 2010-December 2013 were included in this analysis. Patients were stratified according to treatment with prasugrel or clopidogrel and outcomes were compared using propensity score matching. The primary endpoint was a composite of death, recurrent infarction and stroke at hospital discharge. RESULTS: Out of 7621 patients, 2891 received prasugrel (38%) and 4730 received clopidogrel (62%). Independent predictors of in-hospital mortality were age, Killip class >2, STEMI, Charlson comorbidity index >1, and resuscitation prior to admission. After propensity score matching (2301 patients per group), the primary endpoint was significantly lower in prasugrel-treated patients (3.0% vs 4.3%; p=0.022) while bleeding events were more frequent (4.1% vs 3.0%; p=0.048). In-hospital mortality was significantly reduced (1.8% vs 3.1%; p=0.004), but no significant differences were observed in rates of recurrent infarction (0.8% vs 0.7%; p=1.00) or stroke (0.5% vs 0.6%; p=0.85). In a predefined subset of matched patients with one-year follow-up (n=1226), mortality between discharge and one year was not significantly reduced in prasugrel-treated patients (1.3% vs 1.9%, p=0.38). CONCLUSIONS: In everyday practice in Switzerland, prasugrel is predominantly used in younger patients with STEMI undergoing primary PCI. A propensity score-matched analysis suggests a mortality benefit from prasugrel compared with clopidogrel in these patients.
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Kurz et al. (2015) conducted a cohort in Acute coronary syndrome undergoing percutaneous coronary intervention (n=7,621). Prasugrel vs. Clopidogrel was evaluated on Composite of death, recurrent infarction and stroke at hospital discharge (p=0.022). Prasugrel significantly reduced the composite of death, recurrent infarction, and stroke at hospital discharge compared to clopidogrel in ACS patients undergoing PCI (3.0% vs 4.3%; p=0.022).
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