Effects of prasugrel pretreatment on angiographic myocardial perfusion parameters in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Objective Prasugrel is a third-generation thienopyridine, with significant pharmacodynamic and clinical advantages over clopidogrel. There are few data on the effects of prasugrel therapy, as compared with clopidogrel, in terms of perfusion during percutaneous coronary intervention (PCI), in patients with ST-elevation myocardial infarction (STEMI). Methods A total of 128 patients with STEMI, pretreated with prasugrel 60 mg loading dose (mean age=55.9± 9.1; 10.9% were women and 18.0% had diabetes), were compared with 128 propensity-matched patients pretreated with clopidogrel 600mg (mean age=58.7± 10.7; 10.2% were women and 19.5% had diabetes) for the primary endpoint of thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade at completion of the PCI. Secondary endpoints included the combined sum of major adverse events: death, reinfarction or target vessel revascularization at 1 year. Results Mean TIMI flow grade pre-PCI was similar between the two groups (1.31 ± 1.3 in the prasugrel group and 1.30 ± 1.2 in the clopidogrel group, P=0.96). However, after intervention, it was higher in the prasugrel group (2.94± 0.24 vs. 2.84 ± 0.37, respectively, P=0.016), as was myocardial blush (2.70± 0.76 vs. 2.31± 0.52, respectively, P<0.001). The percentage of TIMI 3 after intervention was also higher in the prasugrel group (97.70 vs. 90.60%, P=0.02). The combined rate of major adverse events at 1 year (8.7 vs. 11.6%, P=0.11), as well as total mortality (3.1 ±5.6 vs. 4.7± 9.1%, P=0.52), did not differ between the two groups. Conclusion In patients with STEMI undergoing primary PCI, pretreatment with prasugrel resulted in better angiographic perfusion results, as compared with pretreatment with clopidogrel.