TY - JOUR
TI - Pharmacodynamic Effects of Pre-Hospital Administered Crushed Prasugrel
in Patients With ST-Segment Elevation Myocardial Infarction
AU - Vogel, Rosanne F.
AU - Delewi, Ronak
AU - Angiolillo, Dominick J. and
AU - Wilschut, Jeroen M.
AU - Lemmert, Miguel E.
AU - Diletti, Roberto
AU - van
AU - Vliet, Ria
AU - van der Waarden, Nancy W. P. L.
AU - Nuis, Rutger-Jan and
AU - Paradies, Valeria
AU - Alexopoulos, Dimitrios
AU - Zijlstra, Felix and
AU - Montalescot, Gilles
AU - Krucoff, Mitchell W.
AU - van Mieghem, Nicolas M.
AU - and Smits, Pieter C.
AU - Vlachojannis, Georgios J.
JO - JACC Cardiovascular Interventions
PY - 2021
VL - 14
TODO - 12
SP - 1323-1333
PB - ELSEVIER SCIENCE INC 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA
SN - 1936-8798
TODO - 10.1016/j.jcin.2021.04.022
TODO - crushing; P2Y(12) inhibitors; platelet reactivity; pretreatment; primary
percutaneous coronary intervention; ST-segment elevation myocardial
infarction
TODO - OBJECTIVES This study sought to compare the pharmacodynamic effects of
pre-hospitally administered P2Y(12) inhibitor prasugrel in crushed
versus integral tablet formulation in patients with ST-segment elevation
myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention (pPCI).
BACKGROUND Early dual antiplatelet therapy is recommended in STEMI
patients. Yet, onset of oral P2Y(12) inhibitor effect is delayed and
varies according to formulation administered.
METHODS The COMPARE CRUSH (Comparison of Pre-hospital Crushed Versus
Uncrushed Prasugrel Tablets in Patients With STEMI Undergoing Primary
Percutaneous Coronary Interventions) trial randomized patients with
suspected STEMI to crushed or integral prasugrel 60-mg loading dose in
the ambulance. Pharmacodynamic measurements were performed at 4 time
points: before antiplatelet treatment, at the beginning and end of pPCI,
and 4 h after study treatment onset. The primary endpoint was high
platelet reactivity at the end of pPCI. The secondary endpoint was
impact of platelet reactivity status on markers of coronary reperfusion.
RESULTS A total of 441 patients were included. In patients with crushed
prasugrel, the occurrence of high platelet reactivity at the end of pPCI
was reduced by almost one-half (crushed 34.7% vs. uncrushed 61.6%;
odds ratio [OR] = 0.33; 95% confidence interval [CI] = 0.22 to
0.50; p < 0.01). Platelet reactivity <150 P2Y(12) reactivity units at
the beginning of coronary angiography correlated with improved
Thrombolysis In Myocardial Infarction flow grade 3 in the infarct artery
prepPCI (OR: 1.78; 95% CI: 1.08 to 2.94; p = 0.02) but not ST-segment
resolution (OR: 0.80; 95% CI: 0.48 to 1.34; p = 0.40).
CONCLUSIONS Oral administration of crushed compared with integral
prasugrel significantly improves platelet inhibition during the acute
phase in STEMI patients undergoing pPCI. However, a considerable number
of patients still exhibit inadequate platelet inhibition at the end of
pPCI, suggesting the need for alternative agents to bridge the gap in
platelet inhibition. (C) 2021 by the American College of Cardiology
Foundation.
ER -