Prasugrel vs. Ticagrelor on Myocardial Injury in STEMI

Launched by AORTICA GROUP · Feb 14, 2018

Keywords

ClinConnect Summary

Dual antiplatelet therapy consisting of aspirin and one of the P2Y12 receptor inhibitors is the mainstay of treatment for patients with ST elevation acute myocardial infarction undergoing primary percutaneous coronary intervention. Prasugrel or ticagrelor have actually shown to be superior to clopidogrel improving the prognosis of these patients. However, the industrial interest has avoided any direct comparison between these two antiplatelets. Comparison is of great interest considering that only ticagrelor has shown to significantly reduce mortality. As ticagrelor may exert off-target eff...

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Eligibility criteria

• Inclusion Criteria:
• • age 18 years or older and equal or less than 75 years
• • symptom onset within 12 hours before random assignment
• • chest pain lasting more than 30 minutes
• • ST-segment elevation of at least 0.1 mV in at least 2 limb leads, ST-segment elevation of at least 0.2 mV in 2 or more contiguous precordial leads, or left bundle-branch block or paced rhythm
• • time from symptoms onset to randomization less than 6 hours
• • no severe heart failure (Killip class \<3)
• • informed, written consent
• Exclusion Criteria:
• • history of myocardial infarction with Q wave
• • history of surgical or percutaneous coronary revascularization
• • cardiogenic shock, defined as a systolic blood pressure \<90 mm Hg with no response to fluid administration or \<100 mm Hg in patients with supportive treatment and no bradycardia
• • history of stroke
• • history of bronchial asthma
• • symtomatic sinusal bradicardia or advance AV block
• • history of hypersensitivity to aspirin, prasugrel or ticagrelor or contraindication to the doses established in the study
• • patients pretreated with 600 mg of clopidogrel or more
• • contraindication for the use of gadolinium during the magenitc resonance