Jaya Chandrasekhar1, Usman Baber1, Samantha Sartori1, Melissa Aquino1, Annapoorna S Kini2, Sunil Rao3, William Weintraub4, Timothy D Henry5, Serdar Farhan1, Birgit Vogel1, Sabato Sorrentino1, Zhen Ge1, Samir Kapadia6, Joseph B Muhlestein7, Sandra Weiss4, Craig Strauss8, Catalin Toma9, Anthony DeFranco10, Mark B Effron11, Stuart Keller12, Brian A Baker13, Stuart Pocock14, George Dangas1, Roxana Mehran15. 1. Icahn School of Medicine at Mount Sinai, New York, New York, USA. 2. Mount Sinai Hospital, New York, New York, USA. 3. Duke University, Durham, North Carolina, USA. 4. Christiana Care Health System, Newark, Delaware, USA. 5. Cedars-Sinai Heart Institute, Los Angeles, California, USA. 6. Cleveland Clinic, Cleveland, Ohio, USA. 7. Intermountain Heart Institute, Salt-Lake city, Utah, USA. 8. Minneapolis Heart Institute, Minneapolis, Minnesota, USA. 9. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 10. Aurora Cardiovascular Services, Milwaukee, Wisconsin, USA. 11. Eli Lilly and Company, Indianapolis, Indiana, USA; John Ochsner Heart and Vascular Center, Ochsner Medical Center, New Orleans, Louisiana, USA. 12. Eli Lilly and Company, Indianapolis, Indiana, USA. 13. Daiichi Sankyo, Inc, Parsippany, New Jersey, USA. 14. London School of Hygiene and Tropical Medicine, London, United Kingdom. 15. Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: Roxana.mehran@mountsinai.org.
Abstract
BACKGROUND: Potent P2Y12 inhibitors might offer enhanced benefit against thrombotic events in complex percutaneous coronary intervention (PCI). We examined prasugrel use and outcomes according to PCI complexity, as well as analyzing treatment effects according to thienopyridine type. METHODS: PROMETHEUS was a multicentre observational study that compared clopidogrel vs prasugrel in acute coronary syndrome patients who underwent PCI (n = 19,914). Complex PCI was defined as PCI of the left main, bifurcation lesion, moderate-severely calcified lesion, or total stent length ≥ 30 mm. Major adverse cardiac events (MACE) were a composite of death, myocardial infarction, stroke, or unplanned revascularization. Outcomes were adjusted using multivariable Cox regression for effect of PCI complexity and propensity-stratified analysis for effect of thienopyridine type. RESULTS: The study cohort included 48.9% (n = 9735) complex and 51.1% (n = 10,179) noncomplex patients. Second generation drug-eluting stents were used in 70.1% complex and 66.2% noncomplex PCI patients (P < 0.0001). Complex PCI was associated with greater adjusted risk of 1-year MACE (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.20-1.39; P < 0.001). Prasugrel was prescribed in 20.7% of complex and 20.1% of noncomplex PCI patients (P = 0.30). Compared with clopidogrel, prasugrel significantly decreased adjusted risk for 1-year MACE in complex PCI (HR, 0.79; 95% CI, 0.68-0.92) but not noncomplex PCI (HR, 0.91; 95% CI, 0.77-1.08), albeit there was no evidence of interaction (P interaction = 0.281). CONCLUSIONS: Despite the use of contemporary techniques, acute coronary syndrome patients who undergo complex PCI had significantly higher rates of 1-year MACE. Adjusted magnitude of treatment effects with prasugrel vs clopidogrel were consistent in complex and noncomplex PCI without evidence of interaction.
BACKGROUND: Potent P2Y12 inhibitors might offer enhanced benefit against thrombotic events in complex percutaneous coronary intervention (PCI). We examined prasugrel use and outcomes according to PCI complexity, as well as analyzing treatment effects according to thienopyridine type. METHODS: PROMETHEUS was a multicentre observational study that compared clopidogrel vs prasugrel in acute coronary syndromepatients who underwent PCI (n = 19,914). Complex PCI was defined as PCI of the left main, bifurcation lesion, moderate-severely calcified lesion, or total stent length ≥ 30 mm. Major adverse cardiac events (MACE) were a composite of death, myocardial infarction, stroke, or unplanned revascularization. Outcomes were adjusted using multivariable Cox regression for effect of PCI complexity and propensity-stratified analysis for effect of thienopyridine type. RESULTS: The study cohort included 48.9% (n = 9735) complex and 51.1% (n = 10,179) noncomplex patients. Second generation drug-eluting stents were used in 70.1% complex and 66.2% noncomplex PCI patients (P < 0.0001). Complex PCI was associated with greater adjusted risk of 1-year MACE (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.20-1.39; P < 0.001). Prasugrel was prescribed in 20.7% of complex and 20.1% of noncomplex PCI patients (P = 0.30). Compared with clopidogrel, prasugrel significantly decreased adjusted risk for 1-year MACE in complex PCI (HR, 0.79; 95% CI, 0.68-0.92) but not noncomplex PCI (HR, 0.91; 95% CI, 0.77-1.08), albeit there was no evidence of interaction (P interaction = 0.281). CONCLUSIONS: Despite the use of contemporary techniques, acute coronary syndromepatients who undergo complex PCI had significantly higher rates of 1-year MACE. Adjusted magnitude of treatment effects with prasugrel vs clopidogrel were consistent in complex and noncomplex PCI without evidence of interaction.
Authors: Rayyan Hemetsberger; Mohammad Abdelghani; Ralph Toelg; Hector M Garcia-Garcia; Serdar Farhan; Nader Mankerious; Karim Elbasha; Abdelhakim Allali; Stephan Windecker; Thierry Lefèvre; Shigeru Saito; David Kandzari; Ron Waksman; Gert Richardt Journal: Clin Res Cardiol Date: 2022-02-25 Impact factor: 5.460
Authors: Jaya Chandrasekhar; Usman Baber; Samantha Sartori; Melissa B Aquino; Petr Hájek; Borislav Atzev; Martin Hudec; Tiong Kiam Ong; Martin Mates; Borislav Borisov; Hazem M Warda; Peter den Heijer; Jaroslaw Wojcik; Andres Iniguez; Zdeněk Coufal; Ahmed Khashaba; Muhammad Munawar; Robert T Gerber; Bryan P Yan; Paula Tejedor; Petr Kala; Houng Bang Liew; Michael Lee; Deborah N Kalkman; George D Dangas; Robbert J de Winter; Antonio Colombo; Roxana Mehran Journal: Int J Cardiol Heart Vasc Date: 2020-09-06