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| Open heart. 2017 Nov 28. doi: 10.1136/openhrt-2017-000677. pii: openhrt-2017-000677. pmc: PMC5708315 |
| Early clinical outcomes as a function of use of newer oral P2Y12 inhibitors versus clopidogrel in the EUROMAX trial. |
| Huber K1, Ducrocq G2, Hamm CW3, van 't Hof A4, Lapostolle F5, Coste P6, Gordini G7, Steinmetz J8, Verheugt FWA9, Adgey J10, Nibbe L11, Kaniĉ V12, Clemmensen P13, Zeymer U14, Bernstein D15, Prats J16, Deliargyris EN17, Gabriel Steg P18 |
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Abstract OBJECTIVE: To ascertain whether different oral P2Y12 inhibitors might affect rates of acute stent thrombosis and 30-day outcomes after primary percutaneous coronary intervention (pPCI). METHODS: The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) randomised trial compared prehospital bivalirudin with heparin with optional glycoprotein IIb/IIIa inhibitor treatment in patients with ST-segment elevation myocardial infarction triaged to pPCI. Choice of P2Y12 inhibitor was at the investigator's discretion. In a prespecified analysis, we compared event rates with clopidogrel and newer oral P2Y12 inhibitors (prasugrel, ticagrelor). Rates of the primary outcome (acute stent thrombosis) were examined as a function of the P2Y12 inhibitor used for loading and 30-day outcomes (including major adverse cardiac events) as a function of the P2Y12 inhibitor used for maintenance therapy. Logistic regression was used to adjust for differences in baseline characteristics. RESULTS: Prasugrel or ticagrelor was given as the loading P2Y12 inhibitor in 49% of 2198 patients and as a maintenance therapy in 59%. No differences were observed in rates of acute stent thrombosis for clopidogrel versus newer P2Y12 inhibitors (adjusted OR 0.50, 95% CI 0.13 to 1.85). After adjustment, no difference was observed in 30-day outcomes according to maintenance therapy except for protocol major (p=0.029) or minor (p=0.025) bleeding and Thrombolysis In Myocardial Infarction minor bleeding (p=0.002), which were less frequent in patients on clopidogrel. Consistent results were observed in the bivalirudin and heparin arms. CONCLUSIONS: The choice of prasugrel or ticagrelor over clopidogrel was not associated with differences in acute stent thrombosis or 30-day ischaemic outcomes after pPCI. TRIAL REGISTRATION NUMBER: NCT01087723. |
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KEYWORDS: bivalirudin, clopidogrel, prasugrel, stent thrombosis, ticagrelor |
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Publikations ID: 29225903 Quelle: öffnen |
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