Among antithrombotic agents, prasugrel, but not ticagrelor, is associated with reduced 30 day mortality in patients with ST-elevated myocardial infarction.

Abstract

BACKGROUND:

ST-elevated myocardial infarction (STEMI) holds the highest early mortality among patients with acute coronary syndromes. Despite numerous claims of clinical benefits and superiority over clopidogrel, there are no head-to-head outcome randomized clinical trials (RCTs) directly comparing novel antithrombotic agents in STEMI. Moreover, since most regulatory approvals are based on a single RCT's results, their meta-analyses are rare to compare death rates. We analyzed the 30-day mortality in STEMI patients who underwent percutaneous coronary intervention (PCI) and were treated with antithrombotic agents compared to clopidogrel as a reference.

METHODS AND RESULTS:

Altogether, 10 RCT's and 1 retrospective study with a total number of 26,658 STEMI patients were included. Random-effects model with Mantel-Heanszel weighting was used to pool outcomes into a meta-analysis. Therapy with clopidogrel was associated with 2.76% 30-day STEMI mortality which was similar to that of ticagrelor (2.6%; OR=0.9395 [CI=0.76 to 1.17; p=0.58]), and for bivalirudin (2.8%; OR=1.02 [CI=0.82 to 1.27; p=0.86]), but was slightly higher for heparin (3.0%; OR=1.08 [CI=0.86 to 1.35; p=0.52]). There was a trend towards lower mortality after tirofiban (2.1%; OR=0.77 [CI=0.52 to 1.13; p=0.20]), and cangrelor (1.7%; OR=0.59 [CI=0.29 to 1.20; p=0.19]), although the sample size for both agents was woefully small. The only agent which offers a significant 30-day mortality benefit in STEMI was prasugrel with significant lowest 1.75% death rate (OR=0.63 [CI=0.46 to 0.86; p=0.03]).

CONCLUSIONS:

Among antithrombotic agents, prasugrel, but not ticagrelor, offers significant 30-day mortality benefit over clopidogrel in PCI-treated STEMI patients justifying short-term use in such a high-risk population.

• Authors: Victor L Serebruany, Vasily Cherepanov, Ales Tomek, Moo Hyun Kim
• Journal: International journal of cardiology (Int J Cardiol) Vol. 195 Pg. 104-10 (Sep 15 2015) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 26043353 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Prasugrel Hydrochloride
• Ticagrelor
• Adenosine
• Ticlopidine

Topics

• Adenosine (analogs & derivatives, pharmacology)
• Clopidogrel
• Electrocardiography (methods)
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, drug therapy, mortality, surgery)
• Outcome Assessment, Health Care
• Percutaneous Coronary Intervention (methods)
• Platelet Aggregation Inhibitors (pharmacology)
• Prasugrel Hydrochloride (pharmacology)
• Randomized Controlled Trials as Topic
• Survival Analysis
• Ticagrelor
• Ticlopidine (analogs & derivatives, pharmacology)