Pretreatment with Prasugrel in Non–ST-Segment Elevation Acute Coronary Syndromes

摘要: BACKGROUND: Although P2Y12 antagonists are effective in patients with non-ST-segment elevation (NSTE) acute coronary syndromes, the effect of timing administration--before or after angiography--is not known. We evaluated administering antagonist prasugrel at time diagnosis versus it angiography if percutaneous intervention (PCI) was indicated. METHODS: enrolled 4033 NSTE syndromes and a positive troponin level who were scheduled to undergo within 2 48 hours randomization. Patients randomly assigned receive (a 30-mg loading dose) before (pretreatment group) placebo (control group). When PCI indicated, an additional 30 mg given pretreatment group 60 control group. RESULTS: The rate primary efficacy end point, composite death from cardiovascular causes, myocardial infarction, stroke, urgent revascularization, glycoprotein IIb/IIIa inhibitor rescue therapy (glycoprotein bailout) through day 7, did differ significantly between two groups (hazard ratio pretreatment, 1.02; 95% confidence interval [CI], 0.84 1.25; P=0.81). key safety point all Thrombolysis Myocardial Infarction (TIMI) major bleeding episodes, whether related coronary-artery bypass grafting (CABG), 7 increased ratio, 1.90; CI, 1.19 3.02; P=0.006). rates TIMI life-threatening CABG by factor 3 6, respectively. Pretreatment reduce outcome among undergoing (69% patients) but days. All results confirmed days prespecified subgroups. CONCLUSIONS: Among catheterization, ischemic events up complications. (Funded Daiichi Sankyo Eli Lilly; ACCOAST ClinicalTrials.gov number, NCT01015287.).