Background: Prasugrel is a 3rd generation thienopyridine, with significant pharmacodynamic and clinical advantages over clopidogrel. There is limited data regarding the effects of prasugrel therapy, as compared with clopidogrel, in terms of perfusion during primary percutaneous intervention (PCI), in patients with ST-elevation myocardial infarction (STEMI).
Methods: One hundred and twenty eight patients with STEMI, pre-treated with prasugrel (mean age = 55.9±9.1, 10.9% women and 18.0% had diabetes) were compared with 128 propensity-matched patients treated with clopidogrel 600mg loading (mean age = 58.7±10.7, 10.2% women and 19.5% had diabetes) for the primary end point of Thrombolysis in Myocardial Infarction (TIMI) flow and myocardial blush grade at completion of the PCI. Secondary end points included the combined sum of major adverse events: death, re-infarction or target vessel revascularization at 1 year.
Results: Mean TIMI score pre-PCI was similar between the two groups (1.31±1.31 in the prasugrel, 1.29±1.22 in the clopidogrel group, p=0.96). However, TIMI score post intervention was higher in the prasugrel group (2.97±0.15 vs. 2.91±0.29, respectively, p=0.04), as was myocardial blush (2.70±0.23 vs. 2.33±0.45, respectively, P=0.0006). The percentage of TIMI 3 post intervention was also higher in the prasugrel group (97.7% vs. 90.6%, p=0.017). The combined rate of major adverse events at one year (14.7±3.6% vs. 16.0±3.7%, p=0.8), as well as total mortality (3.8±5.6% vs. 4.8±9.1%, p=0.7), did not differ between the two groups.
Conclusion: In patients with ST-elevation myocardial infarction undergoing primary PCI, pre-treatment with prasugrel resulted in better angiographic perfusion results, as compared with pre-treatment with clopidogrel.
