Abstract | BACKGROUND: METHODS: We conducted a randomized controlled, multicenter trial in the Netherlands, enrolling patients with ST-segment-elevation myocardial infarction scheduled to undergo pPCI. Patients were randomly allocated to receive in the ambulance, before transfer, a 60-mg loading dose of prasugrel either as crushed or integral tablets. The independent primary end points were thrombolysis in myocardial infarction (TIMI) 3 flow in the infarct-related artery at initial coronary angiography, and complete (≥70%) ST-segment resolution 1 hour after pPCI. The safety end points were TIMI major and Bleeding Academic Research Consortium ≥3 bleedings. Secondary end points included platelet reactivity and ischemic outcomes. RESULTS: A total of 727 patients were assigned to either crushed or integral tablets of prasugrel loading dose. The median time from study treatment to wire-crossing during pPCI was 57 (47-70) minutes. The primary end point TIMI 3 flow in the infarct-related artery before pPCI occurred in 31.0% in the crushed group versus 32.7% in the integral group (odds ratio, 0.92 [95% CI, 0.65-1.30], P=0.64). Complete ST-segment resolution 1 hour after pPCI was present in 59.9% in the crushed group versus 57.3% in the integral group (odds ratio, 1.11 [95% CI, 0.78-1.58], P=0.55). Platelet reactivity at the beginning of pPCI, measured as P2Y12 reactivity unit, differed significantly between groups (crushed, 192 [132-245] versus integral, 227 [184-254], P≤0.01). TIMI major and Bleeding Academic Research Consortium ≥3 bleeding occurred in 0% in the crushed group versus 0.8% in the integral group, and in 0.3% in the crushed group versus 1.1% in the integral group, respectively. There were no differences observed between groups regarding ischemic events at 30 days. CONCLUSIONS: Prehospital administration of crushed prasugrel tablets does not improve TIMI 3 flow in the infarct-related artery before pPCI or complete ST-segment resolution 1 h after pPCI in patients presenting with ST-segment-elevation myocardial infarction scheduled for pPCI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03296540.
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Authors | Georgios J Vlachojannis, Jeroen M Wilschut, Rosanne F Vogel, Miguel E Lemmert, Ronak Delewi, Roberto Diletti, Nancy W P L van der Waarden, Rutger-Jan Nuis, Valeria Paradies, Dimitrios Alexopoulos, Felix Zijlstra, Gilles Montalescot, Dominick J Angiolillo, Mitchell W Krucoff, Nicolas M Van Mieghem, Pieter C Smits |
Journal | Circulation
(Circulation)
Vol. 142
Issue 24
Pg. 2316-2328
(12 15 2020)
ISSN: 1524-4539 [Electronic] United States |
PMID | 33315489
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Platelet Aggregation Inhibitors
- Purinergic P2Y Receptor Antagonists
- Tablets
- Prasugrel Hydrochloride
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Topics |
- Aged
- Ambulances
- Blood Platelets
(drug effects, metabolism)
- Drug Administration Schedule
- Emergency Medical Services
- Female
- Hemorrhage
(chemically induced)
- Humans
- Male
- Middle Aged
- Netherlands
- Percutaneous Coronary Intervention
(adverse effects)
- Platelet Aggregation Inhibitors
(administration & dosage, adverse effects)
- Prasugrel Hydrochloride
(administration & dosage, adverse effects)
- Prospective Studies
- Purinergic P2Y Receptor Antagonists
(administration & dosage, adverse effects)
- ST Elevation Myocardial Infarction
(diagnosis, therapy)
- Tablets
- Time Factors
- Time-to-Treatment
- Treatment Outcome
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