title: Mortality in primary angioplasty patients starting antiplatelet therapy with prehospital prasugrel or clopidogrel: a 1-year follow-up from the European MULTIPRAC Registry.
abstract: OBJECTIVE
  MULTIPRAC was designed to provide insights into the use and outcomes associated with prehospital initiation of antiplatelet therapy with either prasugrel or clopidogrel in the context of primary percutaneous coronary intervention. After a previous report on efficacy and safety outcomes during hospitalization, we report here the 1-year follow-up data, including cardiovascular (CV) mortality.
  
  
  RESULTS
  MULTIPRAC is a multinational, prospective registry of patients with ST-elevation myocardial infarction (STEMI) from 25 hospitals in nine countries, all of which had an established practice of prehospital start of dual antiplatelet therapy in place. The key outcome was CV death at 1 year. Among 2,036 patients followed-up through 1 year, 49 died (2.4%), 10 during the initial hospitalization and 39 within 1 year after hospital discharge. The primary analysis was based on the P2Y12-inhibitor, used from prehospital loading dose through hospital discharge. Prasugrel (n=824) was more commonly used than clopidogrel (n=425). The observed 1-year rates for CV death were 0.5% with prasugrel and 2.6% with clopidogrel. After adjustment for differences in baseline characteristics, treatment with prasugrel was associated with a significantly lower risk of CV death than treatment with clopidogrel (odds ratio 0.248; 95% confidence interval 0.06-0.89).
  
  
  CONCLUSIONS
  In STEMI patients from routine practice undergoing primary angioplasty, who were able to start oral antiplatelet therapy prehospital, treatment with prasugrel as compared to clopidogrel was associated with a lower risk of CV death at 1-year follow-up.
authors.affiliation: Emergency Department, Lille Regional University Hospital, Lille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Goldstein
authors.affiliation: Department of Cardiology, Hospital Niguarda Cà Granda Milano, Milan, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Grieco
authors.affiliation: Internal Medicine Centre, Cardiology Department, Rostock University Clinic, Rostock, Germany; Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ince
authors.affiliation: Department of Cardiology, European Hospital Georges-Pompidou, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: Medical Department, Daiichi Sankyo Europe, Munich, Germany.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Ramos
authors.affiliation: Medical Department, Lilly Deutschland GmbH, Bad Homburg, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Goedicke
authors.affiliation: Department of Medicine, Division of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Department of Medicine, Division of Cardiology, Nykoebing F Hospital, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
mesh_terms: D000284:Administration, Oral; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D000077144:Clopidogrel; D004334:Drug Administration Schedule; D004632:Emergency Medical Services / Q000379:methods*; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine
keywords: P2Y12-inhibitor; dual antiplatelet therapy; observational; primary percutaneous coronary intervention; upstream treatment