Comparison of Ticagrelor Versus Prasugrel to Prevent Periprocedural Myonecrosis in Acute Coronary Syndromes
Guidelines recommend a ticagrelor loading dose (LD) before PCI or a prasugrel LD at the time of percutaneous coronary intervention (PCI) in intermediate and high-risk non–ST-elevation acute coronary syndrome (NSTE-ACS). However, achieving an optimal PR inhibition at the time of PCI is critical to pr...
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| Veröffentlicht in: | The American journal of cardiology 2015-08, Vol.116 (3), p.339-343 |
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| creator | Bonello, Laurent, MD, PhD Laine, Marc, MD Cluzel, Marion, MD Frere, Corinne, MD, PhD Mancini, Julien, MD, PhD Hasan, Aurasse, MD Thuny, Franck, MD, PhD Gaubert, Mélanie, MD Guieu, Régis, MD, PhD Dignat-George, Françoise, PhD Michelet, Pierre, MD, PhD Paganelli, Franck, MD, PhD Kerbaul, François, MD, PhD |
| description | Guidelines recommend a ticagrelor loading dose (LD) before PCI or a prasugrel LD at the time of percutaneous coronary intervention (PCI) in intermediate and high-risk non–ST-elevation acute coronary syndrome (NSTE-ACS). However, achieving an optimal PR inhibition at the time of PCI is critical to prevent adverse events and depends on the timing of LD intake in relation to PCI. We aimed to compare the rate of myonecrosis related to PCI in patients with NSTE-ACS receiving ticagrelor pretreatment versus prasugrel at the time of intervention. We prospectively randomized 213 patients with NSTE-ACS to a 180 mg of ticagrelor LD given as soon as possible after admission and before PCI or to a 60 mg LD of prasugrel given at the time of PCI. The primary end point was the rate of periprocedural myonecrosis as defined by an increase of >5 times the ninety-ninth percentiles in troponin-negative patients or a 20% increase in troponin-positive patients. The 2 groups were similar regarding baseline characteristics including clinical setting (p = 0.2). Procedural characteristics were also identical including the number of treated vessels and stenting procedures. Patients in the prasugrel group more often required emergent PCI (p = 0.001). Patients in the ticagrelor group had less periprocedural myonecrosis compared with those in the prasugrel group (19.8% vs 38.3%; p = 0.03). The rate of major adverse cardiovascular events and Bleeding Academic Research Consortium ≥2 at 1-month follow-up was low and similar between the 2 groups. In conclusion, a ticagrelor LD as soon as possible before PCI is superior to prasugrel at the time of PCI to prevent periprocedural myonecrosis in NSTE-ACS. |
| doi_str_mv | 10.1016/j.amjcard.2015.04.050 |
| format | Article |
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However, achieving an optimal PR inhibition at the time of PCI is critical to prevent adverse events and depends on the timing of LD intake in relation to PCI. We aimed to compare the rate of myonecrosis related to PCI in patients with NSTE-ACS receiving ticagrelor pretreatment versus prasugrel at the time of intervention. We prospectively randomized 213 patients with NSTE-ACS to a 180 mg of ticagrelor LD given as soon as possible after admission and before PCI or to a 60 mg LD of prasugrel given at the time of PCI. The primary end point was the rate of periprocedural myonecrosis as defined by an increase of >5 times the ninety-ninth percentiles in troponin-negative patients or a 20% increase in troponin-positive patients. The 2 groups were similar regarding baseline characteristics including clinical setting (p = 0.2). Procedural characteristics were also identical including the number of treated vessels and stenting procedures. Patients in the prasugrel group more often required emergent PCI (p = 0.001). Patients in the ticagrelor group had less periprocedural myonecrosis compared with those in the prasugrel group (19.8% vs 38.3%; p = 0.03). The rate of major adverse cardiovascular events and Bleeding Academic Research Consortium ≥2 at 1-month follow-up was low and similar between the 2 groups. In conclusion, a ticagrelor LD as soon as possible before PCI is superior to prasugrel at the time of PCI to prevent periprocedural myonecrosis in NSTE-ACS.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2015.04.050</identifier><identifier>PMID: 26037292</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject><![CDATA[Acute Coronary Syndrome - complications ; Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - drug therapy ; Acute coronary syndromes ; Adenosine - administration & dosage ; Adenosine - analogs & derivatives ; Adolescent ; Adult ; Aged ; Cardiology ; Cardiovascular ; Consortia ; Dose-Response Relationship, Drug ; Drug dosages ; Electrocardiography ; Female ; Follow-Up Studies ; Heart attacks ; Humans ; Male ; Middle Aged ; Myocardial Infarction - etiology ; Myocardial Infarction - prevention & control ; Piperazines - administration & dosage ; Prasugrel Hydrochloride ; Prospective Studies ; Purinergic P2Y Receptor Antagonists - administration & dosage ; Stroke ; Studies ; Thiophenes - administration & dosage ; Treatment Outcome ; Young Adult]]></subject><ispartof>The American journal of cardiology, 2015-08, Vol.116 (3), p.339-343</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Aug 1, 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-481cb0f77c80e0a09e094c96eeba735d0fc04ed57a316a7de0b236bdd8f385373</citedby><cites>FETCH-LOGICAL-c481t-481cb0f77c80e0a09e094c96eeba735d0fc04ed57a316a7de0b236bdd8f385373</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1694861561?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26037292$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bonello, Laurent, MD, PhD</creatorcontrib><creatorcontrib>Laine, Marc, MD</creatorcontrib><creatorcontrib>Cluzel, Marion, MD</creatorcontrib><creatorcontrib>Frere, Corinne, MD, PhD</creatorcontrib><creatorcontrib>Mancini, Julien, MD, PhD</creatorcontrib><creatorcontrib>Hasan, Aurasse, MD</creatorcontrib><creatorcontrib>Thuny, Franck, MD, PhD</creatorcontrib><creatorcontrib>Gaubert, Mélanie, MD</creatorcontrib><creatorcontrib>Guieu, Régis, MD, PhD</creatorcontrib><creatorcontrib>Dignat-George, Françoise, PhD</creatorcontrib><creatorcontrib>Michelet, Pierre, MD, PhD</creatorcontrib><creatorcontrib>Paganelli, Franck, MD, PhD</creatorcontrib><creatorcontrib>Kerbaul, François, MD, PhD</creatorcontrib><title>Comparison of Ticagrelor Versus Prasugrel to Prevent Periprocedural Myonecrosis in Acute Coronary Syndromes</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Guidelines recommend a ticagrelor loading dose (LD) before PCI or a prasugrel LD at the time of percutaneous coronary intervention (PCI) in intermediate and high-risk non–ST-elevation acute coronary syndrome (NSTE-ACS). However, achieving an optimal PR inhibition at the time of PCI is critical to prevent adverse events and depends on the timing of LD intake in relation to PCI. We aimed to compare the rate of myonecrosis related to PCI in patients with NSTE-ACS receiving ticagrelor pretreatment versus prasugrel at the time of intervention. We prospectively randomized 213 patients with NSTE-ACS to a 180 mg of ticagrelor LD given as soon as possible after admission and before PCI or to a 60 mg LD of prasugrel given at the time of PCI. The primary end point was the rate of periprocedural myonecrosis as defined by an increase of >5 times the ninety-ninth percentiles in troponin-negative patients or a 20% increase in troponin-positive patients. The 2 groups were similar regarding baseline characteristics including clinical setting (p = 0.2). Procedural characteristics were also identical including the number of treated vessels and stenting procedures. Patients in the prasugrel group more often required emergent PCI (p = 0.001). Patients in the ticagrelor group had less periprocedural myonecrosis compared with those in the prasugrel group (19.8% vs 38.3%; p = 0.03). The rate of major adverse cardiovascular events and Bleeding Academic Research Consortium ≥2 at 1-month follow-up was low and similar between the 2 groups. 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Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bonello, Laurent, MD, PhD</au><au>Laine, Marc, MD</au><au>Cluzel, Marion, MD</au><au>Frere, Corinne, MD, PhD</au><au>Mancini, Julien, MD, PhD</au><au>Hasan, Aurasse, MD</au><au>Thuny, Franck, MD, PhD</au><au>Gaubert, Mélanie, MD</au><au>Guieu, Régis, MD, PhD</au><au>Dignat-George, Françoise, PhD</au><au>Michelet, Pierre, MD, PhD</au><au>Paganelli, Franck, MD, PhD</au><au>Kerbaul, François, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Ticagrelor Versus Prasugrel to Prevent Periprocedural Myonecrosis in Acute Coronary Syndromes</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2015-08-01</date><risdate>2015</risdate><volume>116</volume><issue>3</issue><spage>339</spage><epage>343</epage><pages>339-343</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Guidelines recommend a ticagrelor loading dose (LD) before PCI or a prasugrel LD at the time of percutaneous coronary intervention (PCI) in intermediate and high-risk non–ST-elevation acute coronary syndrome (NSTE-ACS). However, achieving an optimal PR inhibition at the time of PCI is critical to prevent adverse events and depends on the timing of LD intake in relation to PCI. We aimed to compare the rate of myonecrosis related to PCI in patients with NSTE-ACS receiving ticagrelor pretreatment versus prasugrel at the time of intervention. We prospectively randomized 213 patients with NSTE-ACS to a 180 mg of ticagrelor LD given as soon as possible after admission and before PCI or to a 60 mg LD of prasugrel given at the time of PCI. The primary end point was the rate of periprocedural myonecrosis as defined by an increase of >5 times the ninety-ninth percentiles in troponin-negative patients or a 20% increase in troponin-positive patients. The 2 groups were similar regarding baseline characteristics including clinical setting (p = 0.2). Procedural characteristics were also identical including the number of treated vessels and stenting procedures. Patients in the prasugrel group more often required emergent PCI (p = 0.001). Patients in the ticagrelor group had less periprocedural myonecrosis compared with those in the prasugrel group (19.8% vs 38.3%; p = 0.03). The rate of major adverse cardiovascular events and Bleeding Academic Research Consortium ≥2 at 1-month follow-up was low and similar between the 2 groups. In conclusion, a ticagrelor LD as soon as possible before PCI is superior to prasugrel at the time of PCI to prevent periprocedural myonecrosis in NSTE-ACS.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26037292</pmid><doi>10.1016/j.amjcard.2015.04.050</doi><tpages>5</tpages></addata></record> |
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| subjects | Acute Coronary Syndrome - complications Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - drug therapy Acute coronary syndromes Adenosine - administration & dosage Adenosine - analogs & derivatives Adolescent Adult Aged Cardiology Cardiovascular Consortia Dose-Response Relationship, Drug Drug dosages Electrocardiography Female Follow-Up Studies Heart attacks Humans Male Middle Aged Myocardial Infarction - etiology Myocardial Infarction - prevention & control Piperazines - administration & dosage Prasugrel Hydrochloride Prospective Studies Purinergic P2Y Receptor Antagonists - administration & dosage Stroke Studies Thiophenes - administration & dosage Treatment Outcome Young Adult |
| title | Comparison of Ticagrelor Versus Prasugrel to Prevent Periprocedural Myonecrosis in Acute Coronary Syndromes |
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