Toggle Main Menu Toggle Search

Open Access padlockePrints

Antiplatelet Therapy in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: A Retrospective Observational Study of Prasugrel and Clopidogrel

Lookup NU author(s): Dr Karthik Balasubramaniam, Professor Azfar Zaman


Full text for this publication is not currently held within this repository. Alternative links are provided below where available.


BackgroundPrimary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is a therapeutic success when supported by dual antiplatelet therapy. Prasugrel has been introduced as a potential alternative to clopidogrel alongside aspirin. We aimed to assess prasugrel versus clopidogrel mortality outcomes in patients admitted with STEMI undergoing PPCI. MethodsRetrospective analysis of prospectively collected data of 1688 consecutive STEMI patients undergoing PPCI at a regional tertiary centre. Patients with age 75years, weight<60kg or history of cerebrovascular accident or TIA's, active bleeding or known hepatic impairment were excluded. All patients from March 2008 to 16 December 2009 belong to the Clopidogrel group and from 17 December 2009 to June 2011 belong to the Prasugrel group. ResultsA total of 866 patients were in the Clopidogrel group and 822 patients in the prasugrel group. In-hospital mortality was 1.7% in the Clopidogrel and 1.5% in Prasugrel group (P=0.40). 30-day postdischarge mortality was 2.4% and 1.8% (P=0.25) in the Clopidogrel and Prasugrel group, respectively. One-year mortality rate was recorded in 62 patients (3.7%): 39 (4.5%) in the Clopidogrel group and 23 (2.8%) in the prasugrel group. In the Cox proportional hazard model, the adjusted hazard ratio for all-cause mortality for the prasugrel group was 0.47 (95% CI: 0.253-0.881; P=0.018). Independent predictors of one-year mortality postdischarge were age, admission creatinine and haemoglobin, admission heart rate, total ischaemic time, the presence of multivessel coronary artery disease, previous MI and post-PCI TIMI flow. ConclusionIn PPCI-treated STEMI patients, prasugrel is associated with a significant reduction in one-year mortality compared with clopidogrel.

Publication metadata

Author(s): Koshy A, Balasubramaniam K, Noman A, Zaman AG

Publication type: Article

Publication status: Published

Journal: Cardiovascular Therapeutics

Year: 2014

Volume: 32

Issue: 1

Pages: 1-6

Print publication date: 01/02/2014

ISSN (print): 1755-5914

ISSN (electronic): 1755-5922

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1111/1755-5922.12051


Altmetrics provided by Altmetric


Funder referenceFunder name