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Article
Use of prasugrel vs clopidogrel and outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention in contemporary clinical practice: Results from the PROMETHEUS study
American heart journal
  • Usman Baber
  • Samantha Sartori
  • Melissa Aquino
  • Annapoorna Kini
  • Samir Kapadia
  • Sandra Weiss
  • Craig Strauss
  • J Brent Muhlestein
  • Catalin Toma
  • Sunil V Rao
  • Anthony C De Franco, Aurora Health Care
  • Kanhaiya L Poddar
  • Jaya Chandrasekhar
  • William Weintraub
  • Timothy D Henry
  • Sameer Bansilal
  • Brian A Baker
  • Elizabeth Marrett
  • Stuart Keller
  • Mark Effron
  • Stuart Pocock
  • Roxana Mehran
Aurora Affiliations

Aurora Cardiovascular Services

Publication Date
6-1-2017
Abstract

BACKGROUND AND OBJECTIVES: We sought to determine the frequency of use and association between prasugrel and outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI) in clinical practice.

METHODS: PROMETHEUS was a multicenter observational registry of acute coronary syndrome patients undergoing PCI from 8 centers in the United States that maintained a prospective PCI registry for patient outcomes. The primary end points were major adverse cardiovascular events at 90days, a composite of all-cause death, nonfatal myocardial infarction, stroke, or unplanned revascularization. Major bleeding was defined as any bleeding requiring hospitalization or blood transfusion. Hazard ratios (HRs) were generated using multivariable Cox regression and stratified by the propensity to treat with prasugrel.

RESULTS: Of 19,914 patients (mean age 64.4years, 32% female), 4,058 received prasugrel (20%) and 15,856 received clopidogrel (80%). Prasugrel-treated patients were younger with fewer comorbid risk factors compared with their counterparts receiving clopidogrel. At 90days, there was a significant association between prasugrel use and lower major adverse cardiovascular event (5.7% vs 9.6%, HR 0.58, 95% CI 0.50-0.67, P

CONCLUSIONS: In contemporary clinical practice, patients receiving prasugrel tend to have a lower-risk profile compared with those receiving clopidogrel. The lower ischemic and bleeding events associated with prasugrel use were no longer evident after accounting for these baseline differences.

Document Type
Article
PubMed ID
28577683
DOI
10.1016/j.ahj.2017.02.013
Citation Information

Baber U, Sartori S, Aquino M, et al. Use of prasugrel vs clopidogrel and outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention in contemporary clinical practice: Results from the PROMETHEUS study. Am Heart J. 2017;188:73-81. DOI: 10.1016/j.ahj.2017.02.013