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Associations Between Complex PCI and Prasugrel or Clopidogrel Use in Patients With Acute Coronary Syndrome Who Undergo PCI: From the PROMETHEUS Study

Authors :
Zhen Ge
George Dangas
Stuart J. Pocock
Joseph B. Muhlestein
Catalin Toma
Samantha Sartori
Melissa Aquino
Samir R. Kapadia
Serdar Farhan
Brian A. Baker
Sunil V. Rao
Craig Strauss
Mark B. Effron
Jaya Chandrasekhar
Birgit Vogel
Sandra Weiss
Timothy D. Henry
Sabato Sorrentino
Stuart Keller
Anthony C. DeFranco
William S. Weintraub
Roxana Mehran
Usman Baber
Annapoorna Kini
Source :
Canadian Journal of Cardiology. 34:319-329
Publication Year :
2018
Publisher :
Elsevier BV, 2018.

Abstract

BACKGROUND: Potent P2Y12 inhibitors might offer enhanced benefit against thrombotic events in complex percutaneous coronary intervention (PCI). We examined prasugrel use and outcomes according to PCI complexity, as well as analyzing treatment effects according to thienopyridine type. METHODS: PROMETHEUS was a multicentre observational study that compared clopidogrel vs prasugrel in acute coronary syndrome patients who underwent PCI (n = 19,914). Complex PCI was defined as PCI of the left main, bifurcation lesion, moderate-severely calcified lesion, or total stent length ≥ 30 mm. Major adverse cardiac events (MACE) were a composite of death, myocardial infarction, stroke, or unplanned revascularization. Outcomes were adjusted using multivariable Cox regression for effect of PCI complexity and propensity-stratified analysis for effect of thienopyridine type. RESULTS: The study cohort included 48.9% (n = 9735) complex and 51.1% (n = 10,179) noncomplex patients. Second generation drug-eluting stents were used in 70.1% complex and 66.2% noncomplex PCI patients (P < 0.0001). Complex PCI was associated with greater adjusted risk of 1-year MACE (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.20-1.39; P < 0.001). Prasugrel was prescribed in 20.7% of complex and 20.1% of noncomplex PCI patients (P = 0.30). Compared with clopidogrel, prasugrel significantly decreased adjusted risk for 1-year MACE in complex PCI (HR, 0.79; 95% CI, 0.68-0.92) but not noncomplex PCI (HR, 0.91; 95% CI, 0.77-1.08), albeit there was no evidence of interaction (P interaction = 0.281). CONCLUSIONS: Despite the use of contemporary techniques, acute coronary syndrome patients who undergo complex PCI had significantly higher rates of 1-year MACE. Adjusted magnitude of treatment effects with prasugrel vs clopidogrel were consistent in complex and noncomplex PCI without evidence of interaction.

Details

ISSN :
0828282X
Volume :
34
Database :
OpenAIRE
Journal :
Canadian Journal of Cardiology
Accession number :
edsair.doi.dedup.....65aa7b86046aaa902275b937930f30d1
Full Text :
https://doi.org/10.1016/j.cjca.2017.12.023