title: Use, efficacy and safety of prasugrel in patients with ST segment elevation myocardial infarction scheduled for primary percutaneous coronary intervention in clinical practice. Results of the prospective ATACS-registry.
abstract: BACKGROUND
  Prasugrel compared to clopidogrel has been shown to improve outcome in patients with ST elevation myocardial infarction (STEMI) in the TRITON-TIMI 38 trial. Little is known about the use, efficacy and safety of prasugrel in patients with STEMI in clinical practice.
  
  
  METHODS
  We conducted a prospective registry including patients with STEMI scheduled for primary percutaneous coronary intervention (PCI). Between October 2009 and February 2013 a total of 3291 patients with STEMI receiving a loading dose of either clopidogrel or prasugrel were included in this analysis.
  
  
  RESULTS
  Prasugrel was predominantly used in patients <75 years, body weight >60 kg and those without prior stroke. In-hospital mortality was numerically lower in the prasugrel group (1.7% vs. 4.4%), as well as non-fatal reinfarction (0.2% vs. 0.5%), non-fatal stroke (0.1% vs. 0.3%) and major cardiac and cerebrovascular events (MACCE) (2.1% vs. 5.2%), while there was no difference in major bleeding complications (0.8% vs. 0.9%). In the multivariate analysis the MACCE-rate tended to be lower in prasugrel treated patients (odds ratio 0.71, 95% confidence intervals 0.42-1.08) but bleeding-rates tended to be higher.
  
  
  CONCLUSIONS
  In this real life experience in patients with STEMI scheduled for primary PCI, prasugrel was almost exclusively used in the label-recommended patient population and tended to be more effective but associated with more bleedings compared to clopidogrel. These results support the findings in the STEMI population in the randomized TRITON-TIMI 38 study.
authors.affiliation: Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Germany. Electronic address: Uwe.Zeymer@t-online.de.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.affiliation: Institut für Herzinfarktforschung Ludwigshafen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.affiliation: Zentrallinik Bad Berka, Germany.
authors.forename: Bernward
authors.initials: B
authors.lastname: Lauer
authors.affiliation: Stiftungsklinikum Mittelrhein, Koblenz, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Kaul
authors.affiliation: Universitätsklinikum Ulm, Ulm, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Wöhrle
authors.affiliation: Vivantes Klinikum am Urban, Berlin, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Andresen
authors.affiliation: Klinikum Leverkusen, Leverkusen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schwimmbeck
authors.affiliation: Ostalb-Klinikum Aalen, Aalen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Solzbach
authors.affiliation: Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Germany.
authors.forename: Anselm
authors.initials: A
authors.lastname: Gitt
authors.affiliation: Institut für Herzinfarktforschung Ludwigshafen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Diller
authors.affiliation: Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000068799:Prasugrel Hydrochloride
keywords: Antiplatelet therapy; Clopidogrel; Percutaneous coronary intervention; Prasugrel; ST elevation myocardial infarction