P2Y12 receptor inhibitors are effective in patients experiencing NSTE-ACS, however, the administration timing is not clear. This study evaluated the administration of prasugrel at the time of diagnosis of ACS or after performing coronary angiography when angioplasty was already decided. 4033 patients were included experiencing an NSTE-ACS troponin positive who had planned angiography between 2 and 48 hours after admission. Patients were randomized to 30 mg of prasugrel (loading dose) at admission versus placebo in the control group and then when angiography was performed, if coronary angioplasty was indicated another 30 mg in the pretreatment branch versus full load of 60 mg in the control group . The primary end point was a composite of cardiovascular death, stroke, urgent revascularization, or need for rescue IIBIIIA.
A week after the procedure, the primary end point, was not significantly different between groups. The TIMI bleeding rate was higher in the pre-treatment group.
Conclusion
In patients experiencing an NSET-ACS, pre-treatment with prasugrel showed no benefit in terms of ischemic events and increased bleeding risk complications despite the use of radial access or femoral percutaneous closure devices.
G. Montalescot
2014-05-22
Title: Effect of prasugrel pre-treatment strategy in patients undergoing PCI for NSTEMI: The ACCOAST study