Comparison of Prasugrel and Ticagrelor Antiplatelet Effects in Korean Patients Presenting With ST-Segment Elevation Myocardial Infarction

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  • Lee Young Seok
    Department of Pediatrics, College of Medicine, Dong-A University Global Clinical Trial Center, Dong-A University Hospital
  • Jin Cai De
    Department of Cardiology, College of Medicine, Dong-A University Global Clinical Trial Center, Dong-A University Hospital
  • Kim Moo Hyun
    Department of Cardiology, College of Medicine, Dong-A University Global Clinical Trial Center, Dong-A University Hospital
  • Guo Long Zhe
    Department of Cardiology, College of Medicine, Dong-A University Global Clinical Trial Center, Dong-A University Hospital
  • Cho Young-Rak
    Department of Cardiology, College of Medicine, Dong-A University
  • Park Kyungil
    Department of Cardiology, College of Medicine, Dong-A University
  • Park Jong Sung
    Department of Cardiology, College of Medicine, Dong-A University
  • Park Tae-Ho
    Department of Cardiology, College of Medicine, Dong-A University
  • Kim Young Dae
    Department of Cardiology, College of Medicine, Dong-A University

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  • LATE BREAKING CLINICAL TRIAL (JCS 2015) : Comparison of Prasugrel and Ticagrelor Antiplatelet Effects in Korean Patients Presenting With ST-Segment Elevation Myocardial Infarction

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Background:There is insufficient data on the efficacy of prasugrel and ticagrelor in Korean patients with ST-segment elevation myocardial infarction (STEMI).Methods and Results:In the current double-blind, prospective pilot study, 39 patients with STEMI undergoing primary percutaneous coronary intervention were randomized to receive prasugrel 60 mg loading dose (LD) followed by 10 mg daily maintenance dose (n=19), or ticagrelor 180 mg LD followed by 90 mg twice daily maintenance dose (n=20). We assessed platelet reactivity with the VerifyNow and Vasodilator-Stimulated Phosphoprotein (VASP) P2Y12 assays. Compared to baseline platelet reactivity, both prasugrel and ticagrelor groups achieved similar and significantly lower P2Y12 reaction units (PRU) (259 [IQR: 230 to 281] vs. 28 [12 to 55] for prasugrel; 261 [196 to 286] vs. 43 [11 to 61] for ticagrelor), and platelet reactivity indexes (PRI) (51.2% [39.3 to 61.3] vs. 8.1% [6.1 to 14.7] for prasugrel; 47.5% [38.4 to 50.4] vs. 11.2% [7.1 to 15.5] for ticagrelor, all P values <0.001) at 48 h post-LD. Most patients had low platelet reactivity with 95% PRU values <85 and 82% with PRI <16%.Conclusions:Both prasugrel and ticagrelor were effective for platelet inhibition in Korean STEMI patients with almost no patients exhibiting high platelet reactivity at 48 h after the LD. Our finding of a high number of patients with very low platelet reactivity deserves further studies to assess the safety of the drugs (Prasugrel and Ticagrelor in ST-segment Elevation Myocardial Infarction Study, NCT02075125). (Circ J 2015; 79: 1248–1254)

Journal

  • Circulation Journal

    Circulation Journal 79 (6), 1248-1254, 2015

    The Japanese Circulation Society

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