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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
- 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.
- Subjects :
- Male
medicine.medical_specialty
Acute coronary syndrome
Ticlopidine
Prasugrel
Thienopyridine
medicine.medical_treatment
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Risk Assessment
Severity of Illness Index
Cohort Studies
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Predictive Value of Tests
Internal medicine
medicine
Humans
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Acute Coronary Syndrome
Angioplasty, Balloon, Coronary
Proportional Hazards Models
Retrospective Studies
business.industry
Coronary Thrombosis
Percutaneous coronary intervention
Middle Aged
Prognosis
medicine.disease
Clopidogrel
Combined Modality Therapy
Survival Analysis
United States
Treatment Outcome
surgical procedures, operative
Multivariate Analysis
Conventional PCI
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Prasugrel Hydrochloride
Platelet Aggregation Inhibitors
Mace
medicine.drug
Subjects
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