Pretreatment with 60 mg of prasugrel is more effective than 300 mg of clopidogrel in reducing thrombotic complications with primary percutaneous coronary intervention (PCI). We compared angiographic outcomes and platelet reactivity between treatment with 60 mg of prasugrel and 600 mg of clopidogrel administered before primary PCI. In this single centre non-randomized study, 65 consecutive Asian patients with ST-elevation myocardial infarction (STEMI) received 60 mg of prasugrel before primary PCI. The pre- and post-PCI corrected thrombolysis in myocardial infarction frame count (CTFC) and the 8-h post-treatment platelet vasodilator-stimulated phosphoprotein (VASP) index was compared with a matched historical Asian STEMI cohort (n = 65) receiving 600 mg of clopidogrel pretreatment. Comparing the prasugrel and clopidogrel groups, the mean age was 54.1 ± 10.2 versus 55.5 ± 11.8 years, P = 0.238, and the mean body mass index was 24.6 ± 2.0 versus 24.7 ± 2.8 kg m−2, P = 0.393. The mean pre-PCI CTFC was 82.1 ± 30.2 versus 86.1 ± 27.6, P = 0.045, and the mean post-PCI CTFC was 21.1 ± 13.9 versus 20.1 ± 9.2, P = 0.309. Pre-PCI coronary thrombi were visualised in 6.3 versus 18.1 %, P = 0.038. The median VASP index was 22.2 ± 24.5 versus 70.5 ± 17.5 %, P < 0.001, and high on-treatment platelet reactivity (VASP index > 50 %) was observed in 13.8 versus 84.3 %, P = 0.001. Rescue intracoronary glycoprotein inhibitors were administered to 29.7 versus 51.0 %, P = 0.018, respectively. Treatment with 60 mg of prasugrel before primary PCI was associated with lower platelet reactivity, a modest trend towards better pre-PCI angiographic outcomes, less pre-PCI coronary thrombi and less rescue glycoprotein inhibitor use compared with 600 mg of clopidogrel. The very high frequency of high on-clopidogrel platelet reactivity with 600 mg of clopidogrel in this Asian STEMI cohort deserves further study.
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Corrected thrombolysis in myocardial infarction frame count
ST-elevation myocardial infarction
Percutaneous coronary intervention
Coronary artery bypass grafting
TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibitioN with prasugrel–Thrombolysis In Myocardial Infarction
Mean fluorescent intensity
Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries
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We would like to thank Dr. Richard C. Becker for his thoughtful guidance and critical review of the manuscript.
This study was supported by the Cardiovascular Research Institute, Singapore. Dr. Mark Y. Chan receives salary support from the National Medical Research Council of Singapore (NRMC/CSA/028/2010). The study drug was provided at no cost by Eli-Lilly.
Conflict of interest
Dr. Mark Y. Chan and Matthew T. Roe have received research funding, speaker’s fees and honoraria from Eli-Lilly (Indianapolis, IN). Dr. Adrian Low has received honoraria from Eli-Lilly (Singapore, Singapore). Dr. Mark Y. Chan and Adrian Low have received honoraria from Astra-Zeneca (Singapore, Singapore). Dr. Swee-Guan Teo has received speaker’s fees from Astra-Zeneca (Singapore, Singapore). All other authors do not have any conflict of interests to declare.
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Li, Y., Tai, B., Sia, W. et al. Angiographic and platelet reactivity outcomes with prasugrel 60 mg pretreatment and clopidogrel 600 mg pretreatment in primary percutaneous coronary intervention. J Thromb Thrombolysis 34, 499–505 (2012). https://doi.org/10.1007/s11239-012-0782-y
- Acute myocardial infarction
- Percutaneous coronary intervention
- Platelet reactivity