Upstream clopidogrel, prasugrel, or ticagrelor for patients treated with primary angioplasty: Results of an angiographic randomized pilot study
| Autor: | Carlos R.M. Rodrigues-Sobrinho, Pedro A. Lemos, Patrick W. Serruys, Marco Valgimigli, Fernando Medeiros, Jose C. Nicolau, João Luiz de Alencar Araripe Falcão, Francisco C. Falcão, Kevin Croce, Rafael Carvalho da Silva, José R. Mont'Alverne-Filho |
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| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Prasugrel medicine.medical_treatment 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Radiology Nuclear Medicine and imaging cardiovascular diseases 030212 general & internal medicine Myocardial infarction Thrombus business.industry Percutaneous coronary intervention General Medicine medicine.disease Clopidogrel surgical procedures operative Conventional PCI Cardiology Cardiology and Cardiovascular Medicine business Ticagrelor TIMI circulatory and respiratory physiology medicine.drug |
| Zdroj: | Catheterization and Cardiovascular Interventions. 87:1187-1193 |
| ISSN: | 1522-1946 |
| DOI: | 10.1002/ccd.26334 |
| Popis: | OBJETIVES The main objective of the present randomized pilot study was to explore the effects of upstream prasugrel or ticagrelor or clopidogrel for patients with ST-segment-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). BACKGROUND Administration of clopidogrel "as soon as possible" has been advocated for STEMI. Pretreatment with prasugrel and ticagrelor may improve reperfusion. Currently, the angiographic effects of upstream administration of these agents are poorly understood. METHODS A total of 132 patients with STEMI within the first 12 hr of chest pain referred to primary angioplasty were randomized to upstream clopidogrel (600 mg), prasugrel (60 mg), or ticagrelor (180 mg) while still in the emergency room. All patients underwent protocol-mandated thrombus aspiration. RESULTS Macroscopic thrombus material was retrieved in 79.5% of the clopidogrel group, 65.9% of the prasugrel group, and 54.3% of the ticagrelor group (P = 0.041). At baseline angiography, large thrombus burden was 97.7% vs. 87.8% vs. 80.4% in the clopidogrel, prasugrel, and ticagrelor groups, respectively (P = 0.036). Also, at baseline, 97.7% presented with an occluded target vessel in the clopidogrel group, 87.8% in the prasugrel group and 78.3% in the ticagrelor group (P = 0.019). At the end of the procedure, the percentages of patients with combined TIMI grade III flow and myocardial blush grade III were 52.3% for clopidogrel, 80.5% for prasugrel, and 67.4% for ticagrelor (P = 0.022). CONCLUSIONS In patients with STEMI undergoing primary PCI within 12 hr, upstream clopidogrel, prasugrel or ticagrelor have varying angiographic findings, with a trend toward better results for the latter two agents. © 2015 Wiley Periodicals, Inc. |
| Databáze: | OpenAIRE |
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