Upstream Clopidogrel, Prasugrel, or Ticagrelor for Patients Treated With Primary Angioplasty: Results of an Angiographic Randomized Pilot Study

Imagem de Miniatura
Arquivos
art_MONT'ALVERNE-FILHO_Upstream_Clopidogrel_Prasugrel_or_Ticagrelor_for_Patients_Treated_2016.PDF (161 KB)
Citações na Scopus
6
Tipo de produção
article
Data de publicação
2016
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
WILEY-BLACKWELL
Autores
MONT'ALVERNE-FILHO, Jose R.
RODRIGUES-SOBRINHO, Carlos R. M.
MEDEIROS, Fernando
FALCAO, Francisco C.
FALCAO, Joao L.
CROCE, Kevin J.
VALGIMIGLI, Marco
SERRUYS, Patrick W.
Citação
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, v.87, n.7, p.1187-1193, 2016
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Objetives: The main objective of the present randomized pilot study was to explore the effects of upstream prasugrel or ticagrelor or clopidogrel for patients with ST-segment-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Background: Administration of clopidogrel ""as soon as possible"" has been advocated for STEMI. Pretreatment with prasugrel and ticagrelor may improve reperfusion. Currently, the angiographic effects of upstream administration of these agents are poorly understood. Methods: A total of 132 patients with STEMI within the first 12 hr of chest pain referred to primary angioplasty were randomized to upstream clopidogrel (600 mg), prasugrel (60 mg), or ticagrelor (180 mg) while still in the emergency room. All patients underwent protocol-mandated thrombus aspiration. Results: Macroscopic thrombus material was retrieved in 79.5% of the clopidogrel group, 65.9% of the prasugrel group, and 54.3% of the ticagrelor group (P=0.041). At baseline angiography, large thrombus burden was 97.7% vs. 87.8% vs. 80.4% in the clopidogrel, prasugrel, and ticagrelor groups, respectively (P=0.036). Also, at baseline, 97.7% presented with an occluded target vessel in the clopidogrel group, 87.8% in the prasugrel group and 78.3% in the ticagrelor group (P=0.019). At the end of the procedure, the percentages of patients with combined TIMI grade III flow and myocardial blush grade III were 52.3% for clopidogrel, 80.5% for prasugrel, and 67.4% for ticagrelor (P=0.022). Conclusions: In patients with STEMI undergoing primary PCI within 12 hr, upstream clopidogrel, prasugrel or ticagrelor have varying angiographic findings, with a trend toward better results for the latter two agents. (C) 2015 Wiley Periodicals, Inc.
Palavras-chave
acute myocardial infarction, antiplatelet therapy, coronary angiography, myocardial perfusion
URI
https://observatorio.fm.usp.br/handle/OPI/16134
Referências
  1. Alexopoulos D, 2012, CIRC-CARDIOVASC INTE, V5, P797, DOI 10.1161/CIRCINTERVENTIONS.112.972323
  2. Angiolillo DJ, 2004, EUR HEART J, V25, P1903, DOI 10.1016/j.ehj.2004.07.036
  3. Biscaglia S, 2013, J THROMB HAEMOST, V11, P192, DOI 10.1111/jth.12049
  4. Brener SJ, 2009, AM HEART J, V158, P755, DOI 10.1016/j.ahj.2009.09.009
  5. Chen ZM, 2005, LANCET, V366, P1607
  6. Clemmensen P, 2015, EUR HEART J-ACUTE CA, V4, P220, DOI 10.1177/2048872614547449
  7. Cohen J., 1988, STAT POWER ANAL BEHA
  8. DEWOOD MA, 1980, NEW ENGL J MED, V303, P897, DOI 10.1056/NEJM198010163031601
  9. Dorler J, 2011, EUR HEART J, V32, P2954, DOI 10.1093/eurheartj/ehr360
  10. Gurbel PA, 2005, J AM COLL CARDIOL, V45, P1392, DOI 10.1016/j.jacc.2005.01.030
  11. Hermanides RS, 2012, CATHETER CARDIO INTE, V79, P956, DOI 10.1002/ccd.23165
  12. Huczek Z, 2007, AM HEART J, V154, P62, DOI 10.1016/j.ahj.2007.03.021
  13. Jernberg T, 2006, EUR HEART J, V27, P1166, DOI 10.1093/eurheartj/ehi877
  14. Kohli P, 2013, CIRCULATION, V127, P673, DOI 10.1161/CIRCULATIONAHA.112.124248
  15. Koul S, 2011, EUR HEART J, V32, P2990, DOI 10.1093/eurheartj/ehr202
  16. Li YD, 2012, J THROMB THROMBOLYS, V34, P499, DOI 10.1007/s11239-012-0782-y
  17. Mahaffey KW, 2014, J AM COLL CARDIOL, V63, P1493, DOI 10.1016/j.jacc.2014.01.038
  18. Montalescot G, 2014, NEW ENGL J MED, V371, P1016, DOI 10.1056/NEJMoa1407024
  19. Montalescot G, 2013, NEW ENGL J MED, V369, P999, DOI 10.1056/NEJMoa1308075
  20. Montalescot G, 2009, LANCET, V373, P723, DOI 10.1016/S0140-6736(09)60441-4
  21. Muller I, 2001, HEART, V85, P92, DOI 10.1136/heart.85.1.92
  22. O'Gara PT, 2013, CIRCULATION, V127, pE362, DOI 10.1161/CIR.0b013e3182742cf6
  23. Parodi G, 2013, J AM COLL CARDIOL, V61, P1601, DOI 10.1016/j.jacc.2013.01.024
  24. Sabatine MS, 2005, NEW ENGL J MED, V352, P1179, DOI 10.1056/NEJMoa050522
  25. Sakhuja R, 2010, CURR PROB CARDIOLOGY, V35, P123, DOI [10.1016/j.cpcardiol.2009.11.002, 10.1016/j.cpcardio1.2009.11.002]
  26. Sianos G, 2007, J AM COLL CARDIOL, V50, P573, DOI 10.1016/j.jacc.2007.04.059
  27. Sianos G, 2010, J INVASIVE CARDIOL, V22, p6B
  28. Steg PG, 2010, CIRCULATION, V122, P2131, DOI 10.1161/CIRCULATIONAHA.109.927582
  29. TIMI Study Group, 1985, NEW ENGL J MED, V312, P932, DOI 10.1056/ NEJM198504043121435
  30. Valgimigli M, 2012, JACC-CARDIOVASC INTE, V5, P268, DOI 10.1016/j.jcin.2012.01.006
  31. van't Hof AWJ, 1998, CIRCULATION, V97, P2302
  32. Wallentin L, 2009, NEW ENGL J MED, V361, P1045, DOI 10.1056/NEJMoa0904327
  33. Windecker S, 2014, EUR HEART J, V35, P2541, DOI 10.1093/eurheartj/ehu278
  34. Wiviott SD, 2007, NEW ENGL J MED, V357, P2001, DOI 10.1056/NEJMoa0706482

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/11
Artigos e Materiais de Revistas Científicas - ODS/03