Pharmacodynamic Effects of Pre-Hospital Administered Crushed Prasugrel in Patients With ST-Segment Elevation Myocardial Infarction
| Autor: | Rosanne F. Vogel, Ronak Delewi, Pieter C. Smits, G. Montalescot, Nancy W.P.L. van der Waarden, Roberto Diletti, Jeroen Wilschut, Felix Zijlstra, Nicolas M. Van Mieghem, Dominick J. Angiolillo, Valeria Paradies, Rutger-Jan Nuis, Georgios J. Vlachojannis, Ria van Vliet, Dimitrios Alexopoulos, Mitchell W. Krucoff, Miguel E. Lemmert |
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| Přispěvatelé: | Cardiology, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
platelet reactivity
medicine.medical_specialty Prasugrel P2Y inhibitors medicine.medical_treatment Myocardial Infarction 030204 cardiovascular system & hematology Loading dose 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine P2Y12 Internal medicine medicine Clinical endpoint Humans ST segment 030212 general & internal medicine Myocardial infarction business.industry Percutaneous coronary intervention crushing pretreatment medicine.disease primary percutaneous coronary intervention Hospitals ST-segment elevation myocardial infarction Treatment Outcome surgical procedures operative Pharmacodynamics Purinergic P2Y Receptor Antagonists Cardiology ST Elevation Myocardial Infarction Cardiology and Cardiovascular Medicine business Prasugrel Hydrochloride Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | JACC. Cardiovascular interventions, 14(12), 1323-1333. Elsevier Inc. JACC: Cardiovascular Interventions, 14(12), 1323-1333. Elsevier Inc. |
| ISSN: | 1936-8798 |
| Popis: | Objectives: This study sought to compare the pharmacodynamic effects of pre-hospitally administered P2Y12 inhibitor prasugrel in crushed versus integral tablet formulation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Background: Early dual antiplatelet therapy is recommended in STEMI patients. Yet, onset of oral P2Y12 inhibitor effect is delayed and varies according to formulation administered. Methods: The COMPARE CRUSH (Comparison of Pre-hospital Crushed Versus Uncrushed Prasugrel Tablets in Patients With STEMI Undergoing Primary Percutaneous Coronary Interventions) trial randomized patients with suspected STEMI to crushed or integral prasugrel 60-mg loading dose in the ambulance. Pharmacodynamic measurements were performed at 4 time points: before antiplatelet treatment, at the beginning and end of pPCI, and 4 h after study treatment onset. The primary endpoint was high platelet reactivity at the end of pPCI. The secondary endpoint was impact of platelet reactivity status on markers of coronary reperfusion. Results: A total of 441 patients were included. In patients with crushed prasugrel, the occurrence of high platelet reactivity at the end of pPCI was reduced by almost one-half (crushed 34.7% vs. uncrushed 61.6%; odds ratio [OR] = 0.33; 95% confidence interval [CI] = 0.22 to 0.50; p < 0.01). Platelet reactivity 12 reactivity units at the beginning of coronary angiography correlated with improved Thrombolysis In Myocardial Infarction flow grade 3 in the infarct artery pre-pPCI (OR: 1.78; 95% CI: 1.08 to 2.94; p = 0.02) but not ST-segment resolution (OR: 0.80; 95% CI: 0.48 to 1.34; p = 0.40). Conclusions: Oral administration of crushed compared with integral prasugrel significantly improves platelet inhibition during the acute phase in STEMI patients undergoing pPCI. However, a considerable number of patients still exhibit inadequate platelet inhibition at the end of pPCI, suggesting the need for alternative agents to bridge the gap in platelet inhibition. |
| Databáze: | OpenAIRE |
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