title: Prasugrel versus clopidogrel in acute coronary syndromes treated with PCI: Effects on clinical outcome according to culprit artery location.
abstract: BACKGROUND
  Acute coronary syndrome (ACS) mortality increases when the culprit lesion is in the left anterior descending (LAD) artery. We investigated the effects of prasugrel versus clopidogrel according to site of culprit lesion causing ACS treated with percutaneous coronary intervention (PCI) in the TRITON-TIMI 38 study.
  
  
  METHODS
  Patients were divided into three groups based on the native coronary artery culprit lesion location. The LAD artery group included also patients with the culprit lesion in the left main (LM) artery.
  
  
  RESULTS
  In the whole ACS population, prasugrel recipients had lower rates of the primary endpoint that included cardiovascular (CV) death, non-fatal myocardial infarction (MI) or non-fatal stroke without significant differences across vessel groups. CV death was significantly decreased with prasugrel in the whole ACS population (p=0.03) and in ST-elevation MI (STEMI) patients undergoing primary PCI (p=0.04), with pronounced differences in favour of prasugrel versus clopidogrel when the LAD-LM was the culprit vessel (relative risk reduction 50% in the whole ACS population, 57% in STEMI treated with primary PCI, p for interaction 0.07 and 0.08 respectively).
  
  
  CONCLUSIONS
  Prasugrel effects were particularly favourable when LAD-LM was the culprit vessel, resulting in CV mortality reduction in the whole ACS population and in STEMI patients when treated with primary PCI.
authors: Division of Cardiology and Coronary Care Unit, Fondazione Policlinico San Matteo, Pavia, Italy. Electronic address: s.deservi@smatteo.pv.it.
authors: Stefano
authors: S
authors: De Servi
authors: Scientific Consulting for Pharmaceutical Industry and CROs, Hamburg, Germany.
authors: Jochen
authors: J
authors: Goedicke
authors: Division of Cardiology and Coronary Care Unit, Fondazione Policlinico San Matteo, Pavia, Italy.
authors: Marco
authors: M
authors: Ferlini
authors: Cardiovascular Department, Policlinico S. Orsola, Bologna, Italy.
authors: Tullio
authors: T
authors: Palmerini
authors: Finnish Heart Association, Helsinki, Finland.
authors: Mikko
authors: M
authors: Syvänne
authors: UPMC Sorbonne Universités, ACTION Study Group, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
authors: Gilles
authors: G
authors: Montalescot
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000077144:Clopidogrel; D003331:Coronary Vessels / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine
keywords: Acute coronary syndromes; P2Y12 inhibitors; Prasugrel