Prasugrel versus clopidogrel for acute coronary syndromes without revascularization
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Tarih
2012
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Massachussetts Medical Society
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P = 0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P = 0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. CONCLUSIONS: Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.) Copyright © 2012 Massachusetts Medical Society.
Açıklama
Anahtar Kelimeler
acetylsalicylic acid; clopidogrel; prasugrel; acute coronary syndrome; adult; aged; article; bleeding; brain hemorrhage; cardiovascular mortality; cerebrovascular accident; controlled study; coronary artery bypass surgery; double blind procedure; drug efficacy; female; follow up; heart infarction; human; loading drug dose; major clinical study; male; non ST segment elevation myocardial infarction; percutaneous coronary intervention; priority journal; randomized controlled trial; unstable angina pectoris
Kaynak
New England Journal of Medicine
WoS Q Değeri
Scopus Q Değeri
Q1
Cilt
367
Sayı
14
