title: Effects of prasugrel pretreatment on angiographic myocardial perfusion parameters in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: OBJECTIVE
  Prasugrel is a third-generation thienopyridine, with significant pharmacodynamic and clinical advantages over clopidogrel. There are few data on the effects of prasugrel therapy, as compared with clopidogrel, in terms of perfusion during percutaneous coronary intervention (PCI), in patients with ST-elevation myocardial infarction (STEMI).
  
  
  METHODS
  A total of 128 patients with STEMI, pretreated with prasugrel 60 mg loading dose (mean age=55.9±9.1; 10.9% were women and 18.0% had diabetes), were compared with 128 propensity-matched patients pretreated with clopidogrel 600 mg (mean age=58.7±10.7; 10.2% were women and 19.5% had diabetes) for the primary endpoint of thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade at completion of the PCI. Secondary endpoints included the combined sum of major adverse events: death, reinfarction or target vessel revascularization at 1 year.
  
  
  RESULTS
  Mean TIMI flow grade pre-PCI was similar between the two groups (1.31±1.3 in the prasugrel group and 1.30±1.2 in the clopidogrel group, P=0.96). However, after intervention, it was higher in the prasugrel group (2.94±0.24 vs. 2.84±0.37, respectively, P=0.016), as was myocardial blush (2.70±0.76 vs. 2.31±0.52, respectively, P<0.001). The percentage of TIMI 3 after intervention was also higher in the prasugrel group (97.70 vs. 90.60%, P=0.02). The combined rate of major adverse events at 1 year (8.7 vs. 11.6%, P=0.11), as well as total mortality (3.1±5.6 vs. 4.7±9.1%, P=0.52), did not differ between the two groups.
  
  
  CONCLUSIONS
  In patients with STEMI undergoing primary PCI, pretreatment with prasugrel resulted in better angiographic perfusion results, as compared with pretreatment with clopidogrel.
authors.affiliation: aDepartment of Cardiology, Rabin Medical Center, Petah-Tikva bSackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Leor
authors.initials: L
authors.lastname: Perl
authors.forename: Liat
authors.initials: L
authors.lastname: Sasson
authors.forename: Adaya
authors.initials: A
authors.lastname: Weissler-Snir
authors.forename: Gabriel
authors.initials: G
authors.lastname: Greenberg
authors.forename: Hana
authors.initials: H
authors.lastname: Vaknin-Assa
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: Abid
authors.initials: A
authors.lastname: Assali
authors.forename: Eli I
authors.initials: EI
authors.lastname: Lev
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D016022:Case-Control Studies; D000077144:Clopidogrel; D017023:Coronary Angiography; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D055414:Myocardial Perfusion Imaging; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use*; D011292:Premedication / Q000379:methods*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine; D001241:Aspirin