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Impact of dual antiplatelet therapy with adjusted-dose prasugrel on mid-term vascular response in patients undergoing elective percutaneous coronary intervention with everolimus-eluting stents

  • Takayoshi Toba
  • Toshiro Shinke
  • Hiromasa Otake
  • Yoichiro Sugizaki
  • Ryo Takeshige
  • Hiroyuki Onishi
  • Akira Nagasawa
  • Yoshiro Tsukiyama
  • Kenichi Yanaka
  • Yuichiro Nagano
  • Hiroyuki Yamamoto
  • Hiroyuki Kawamori
  • Akira Matsuura
  • Takayuki Ishihara
  • Daisuke Matsumoto
  • Nobuaki Igarashi
  • Takatoshi Hayashi
  • Yoshinori Yasaka
  • Makoto Kadotani
  • Takashi Fujii
  • Junya Shite
  • Masaharu Okada
  • Takashi Sakakibara
  • Ken-ichi Hirata
Original Article
  • 53 Downloads

Abstract

The impact of dual antiplatelet therapy (DAPT) with adjusted-dose (3.75 mg/day) prasugrel for Japanese patients has not been fully investigated in terms of local arterial healing following the elective percutaneous coronary intervention (PCI). The ROUTE-01 elective study was a prospective, 12-center and single-arm registry that enrolled 123 patients who underwent elective PCI with everolimus-eluting stents (EESs) under DAPT with a combination of adjusted-dose prasugrel and aspirin. Serial optical coherence tomography (OCT) was performed at the index PCI and 9-month follow-up to assess the relationship between in-stent thorombus (IST) and residual platelet reactivity measuring platelet reactivity unit (PRU). The patients were classified as extensive, intermediate, and poor metabolizers by cytochrome P450 2C19 (CYP2C19) loss-of-function polymorphisms. The prevalence of IST was 9.0% by 9-month OCT, with no difference amongst the three groups (p = 0.886). The incidences of malapposed and uncovered struts were not different among the groups. PRU was not statistically different among the groups. In multivariate logistic regression analysis, the independent predictor for IST on 9-month OCT was irregular protrusion (odds ratio = 8.952, p = 0.037) on post-PCI OCT, not CYP2C19 loss-of-function polymorphisms. An adequate anti-thrombotic effect with an acceptable incidence of IST was observed irrespective of CYP2C19 loss-of-function polymorphisms. Our data suggests that adjusted-dose prasugrel and aspirin is a feasible treatment option in Japanese patients treated with EESs in elective PCI.

Keywords

Dual antiplatelet therapy Prasugrel Drug-eluting stent Optical coherence tomography Platelet reactivity 

Notes

Acknowledgments

We acknowledge the support of the institutions that took part in the current study and appreciate the contributions of all the investigators and staff involved in this study.

Funding

The current study was sponsored by Daiichi Sankyo Co., Ltd. (Tokyo, Japan).

Compliance with ethical standards

Conflict of interest

The current study was sponsored by Daiichi Sankyo Co., Ltd. (Tokyo, Japan). The authors declare the following interests: Toshiro Shinke, Hiromasa Otake and Junya Shite are medical advisors for Abbott Vascular Japan Co., Ltd. (Nagoya, Japan). Other authors have nothing to disclose regarding the current study.

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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Takayoshi Toba
    • 1
  • Toshiro Shinke
    • 1
    • 2
  • Hiromasa Otake
    • 1
  • Yoichiro Sugizaki
    • 1
  • Ryo Takeshige
    • 1
  • Hiroyuki Onishi
    • 1
  • Akira Nagasawa
    • 1
  • Yoshiro Tsukiyama
    • 1
  • Kenichi Yanaka
    • 1
  • Yuichiro Nagano
    • 1
  • Hiroyuki Yamamoto
    • 1
  • Hiroyuki Kawamori
    • 1
  • Akira Matsuura
    • 3
  • Takayuki Ishihara
    • 4
  • Daisuke Matsumoto
    • 5
  • Nobuaki Igarashi
    • 6
  • Takatoshi Hayashi
    • 7
  • Yoshinori Yasaka
    • 8
  • Makoto Kadotani
    • 9
  • Takashi Fujii
    • 10
  • Junya Shite
    • 11
  • Masaharu Okada
    • 12
  • Takashi Sakakibara
    • 13
  • Ken-ichi Hirata
    • 1
  1. 1.Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
  2. 2.Showa University School of MedicineTokyoJapan
  3. 3.Akashi Medical CenterAkashiJapan
  4. 4.Kansai Rosai HospitalAmagasakiJapan
  5. 5.Yodogawa Christian HospitalOsakaJapan
  6. 6.Japanese Red Cross Kobe HospitalKobeJapan
  7. 7.Hyogo Prefectural Awaji Medical CenterSumotoJapan
  8. 8.Hyogo Brain and Heart CenterHimejiJapan
  9. 9.Kakogawa Central City HospitalKakogawaJapan
  10. 10.Ako City HospitalAkoJapan
  11. 11.Saiseikai Nakatsu HospitalOsakaJapan
  12. 12.Shiga General HospitalMoriyamaJapan
  13. 13.Nagoya Kyoritsu HospitalNagoyaJapan

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