Abstract | BACKGROUND: METHODS AND RESULTS: We pooled patients with STEMI discharged on prasugrel in 2 prospective registries (Bern PCI Registry [NCT02241291] and SPUM-ACS ( Inflammation and Acute Coronary Syndromes) [NCT01000701]) and 1 STEMI trial (COMFORTABLE-AMI (Comparison of Biomatrix Versus Gazelle in ST-Elevation Myocardial Infarction) [NCT00962416]). Prasugrel treatment status at 1 year was categorized as no cessation; crossover to another P2Y12-inhibitor; physician-recommended discontinuation; and disruption because of bleeding, side effects, or patient noncompliance. In time-dependent analyses, we assessed the impact of prasugrel cessation on the primary end point, a composite of cardiac death, myocardial infarction, and stroke. Of all 1830 included patients (17% women, mean age 59 years), 83% were treated with new-generation drug-eluting stents. At 1 year, any prasugrel cessation had occurred in 13.8% of patients including crossover (7.2%), discontinuation (3.7%), and disruption (2.9%). Independent predictors of any prasugrel cessation included female sex, age, and history of cerebrovascular event. The primary end point occurred in 5.2% of patients and was more frequent following disruption (hazard ratio 3.04, 95% confidence interval,1.34-6.91; P=0.008), without significant impact of crossover or discontinuation. Consistent findings were observed for all-cause death, myocardial infarction, and stent thrombosis following prasugrel disruption. CONCLUSIONS: In this contemporary study of patients with STEMI, early prasugrel cessation was not uncommon and primarily involved change to another P2Y12-inhibitor. Disruption was the only type of early prasugrel cessation associated with statistically significant excess in ischemic risk within 1 year following primary percutaneous coronary interventions.
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Authors | Konstantinos C Koskinas, Thomas Zanchin, Roland Klingenberg, Baris Gencer, Fabrice Temperli, Andreas Baumbach, Marco Roffi, Aris Moschovitis, Oliver Muller, David Tüller, Stefan Stortecky, Francois Mach, Thomas F Lüscher, Christian M Matter, Thomas Pilgrim, Dik Heg, Stephan Windecker, Lorenz Räber |
Journal | Journal of the American Heart Association
(J Am Heart Assoc)
Vol. 7
Issue 8
(04 13 2018)
ISSN: 2047-9980 [Electronic] England |
PMID | 29654204
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
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Copyright | © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. |
Chemical References |
- Platelet Aggregation Inhibitors
- Prasugrel Hydrochloride
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Topics |
- Cause of Death
(trends)
- Coronary Angiography
- Drug-Eluting Stents
- Electrocardiography
- Female
- Follow-Up Studies
- Humans
- Incidence
- Male
- Middle Aged
- Percutaneous Coronary Intervention
(methods)
- Platelet Aggregation Inhibitors
(therapeutic use)
- Prasugrel Hydrochloride
(therapeutic use)
- Prospective Studies
- ST Elevation Myocardial Infarction
(diagnosis, epidemiology, therapy)
- Survival Rate
(trends)
- Switzerland
(epidemiology)
- Time Factors
- Treatment Outcome
- Withholding Treatment
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