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首页> 外文期刊>JACC. Cardiovascular interventions >Prasugrel versus clopidogrel in patients with ST-segment elevation myocardial infarction according to timing of percutaneous coronary intervention: A TRITON-TIMI 38 subgroup analysis (Trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction 38)
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Prasugrel versus clopidogrel in patients with ST-segment elevation myocardial infarction according to timing of percutaneous coronary intervention: A TRITON-TIMI 38 subgroup analysis (Trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction 38)

机译：根据经皮冠状动脉介入治疗的时机，ST段抬高型心肌梗死患者的普拉格雷与氯吡格雷：TRITON-TIMI 38亚组分析（通过优化普拉格雷-溶栓治疗对血小板的抑制作用，评估心肌梗塞38治疗效果的改善）

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Objectives This study sought to evaluate the efficacy of prasugrel versus clopidogrel in ST-segment elevation myocardial infarction (STEMI) by the timing of percutaneous coronary intervention (PCI). Background Treatment strategies and outcomes for patients with STEMI may differ when treated with primary compared with secondary PCI. Methods STEMI patients in the TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis In Myocardial Infarction 38) were randomized to prasugrel or clopidogrel on presentation if primary PCI was intended or later during secondary PCI. Primary PCI was defined as within 12 h of symptom onset. The primary endpoint was cardiovascular death, myocardial infarction (MI), or stroke. Because periprocedural MI is difficult to assess in the setting of STEMI, we performed analyses excluding these events. Results Reductions in the primary endpoint with prasugrel versus clopidogrel (hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.65 to 0.97; p = 0.022) were consistent between primary and secondary PCI patients at 15 months (HR: 0.89; 95% CI: 0.69 to 1.13 vs. HR: 0.65; 95% CI: 0.46 to 0.93; p interaction = 0.15). However, a tendency toward a difference in treatment effect at 30 days (HR: 0.68; 95% CI: 0.54 to 0.87; p = 0.002) was observed between primary and secondary PCI patients (HR: 0.81; 95% CI: 0.60 to 1.09 vs. HR: 0.51; 95% CI: 0.34 to 0.76; p interaction = 0.06). When periprocedural MI was excluded, the efficacy of prasugrel remained consistent among primary and secondary PCI patients at 30 days (HR: 0.53; 95% CI: 0.34 to 0.81 vs. HR: 0.44; 95% CI: 0.22 to 0.88; p interaction = 0.68) and 15 months (HR: 0.76; 95% CI: 0.56 to 1.03 vs. HR: 0.75; 95% CI: 0.46 to 1.21; p interaction = 0.96). Conclusions The efficacy of prasugrel versus clopidogrel was consistent irrespective of the timing of PCI, particularly in preventing nonprocedural events. (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction 38; NCT00097591).
机译：目的本研究旨在通过经皮冠状动脉介入治疗（PCI）的时间来评估普拉格雷与氯吡格雷在ST段抬高型心肌梗死（STEMI）中的疗效。背景与原发性PCI相比，原发性PCI治疗STEMI患者的治疗策略和结果可能有所不同。方法TRITON-TIMI 38（通过在心肌梗塞中通过普拉格雷-溶栓治疗优化血小板抑制来优化治疗效果来评估治疗效果的评估）的STEMI患者（如果打算使用原发性PCI或随后在继发PCI期间随机分配）为普拉格雷或氯吡格雷。原发性PCI定义为症状发作后12小时内。主要终点为心血管死亡，心肌梗塞（MI）或中风。由于在STEMI的情况下难以评估围手术期MI，因此我们进行了排除这些事件的分析。结果普拉格雷与氯吡格雷的主要终点指标降低（危险比[HR]：0.79; 95％置信区间[CI]：0.65至0.97; p = 0.022）在15个月的主要和继发性PCI患者中一致（HR：0.89） ; 95％CI：0.69至1.13，而HR：0.65; 95％CI：0.46至0.93; p相互作用= 0.15）。然而，在原发和继发PCI患者之间观察到30天治疗效果有差异的趋势（HR：0.68; 95％CI：0.54至0.87; p = 0.002）（HR：0.81; 95％CI：0.60至1.09）相对于HR：0.51; 95％CI：0.34至0.76; p相互作用= 0.06）。当排除围手术期MI时，普拉格雷在30天的初次和继发PCI患者中的疗效保持一致（HR：0.53; 95％CI：0.34至0.81; HR：0.44; 95％CI：0.22至0.88; p交互作用= 0.68）和15个月（HR：0.76; 95％CI：0.56至1.03; HR：0.75; 95％CI：0.46至1.21; p相互作用= 0.96）。结论普拉格雷与氯吡格雷的疗效一致，与PCI时机无关，特别是在预防非程序性事件方面。 （通过在心肌梗塞中通过普拉格雷-溶栓治疗优化血小板抑制来评估治疗效果的改善试验38; NCT00097591）。

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