Efficacy of Pre-Treatment with Prasugrel vs. Clopidogrel in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Background & Objective:
The therapeutic impact of pre-treatment with dual anti-platelet medications during ST elevation myocardial infarction (STEMI) is a matter of great controversy. We aim to compare the clinical efficacy of pre-treatment with Prasugrel vs. Clopidogrel in patients presenting with STEMI undergoing primary percutaneous coronary intervention (PPCI).

Methods:
A total of 475 patients with STEMI, pre-treated with Prasugrel 60 mg loading dose (mean age=57.3±9.3; 88% men, 20% DM), were compared with 475 propensity-matched patients pre-treated with Clopidogrel 600 mg (mean age=56.7±11.6; 88% men, 19% DM) for the primary endpoint of major adverse cardiovascular events (MACE= death, re-MI, repeat target vessel revascularization - TVR). Secondary endpoints included death of any cause or recurrent MI.

Results:
TIMI flow 0 at baseline was found in 56% of the Plavix group vs. 50% in the Effient group (p=0.02). Outcomes following one month shows that Prasugrel was associated with lower MACE (6.1% vs. 1.7%, p =0.01), lower mortality (2.3% vs. 0.6% p=0.03), lower re-MI (2.5% vs. 0.7%, p=0.02) and lower rate of TVR (3.4% vs. 0.4%, p=0.01) compared to Clopidogrel. There were no differences found in definite stent thrombosis between the two groups (1.5% vs. 0.4% p=0.1).

Conclusion:
According to our experience, STEMI patients who were pre-treated with Prasugrel prior to PPCI, were found to have better short-term clinical cardiac outcomes compared to Clopiogrel pre-treatment.