Early clinical outcomes as a function of use of newer oral P2Yinhibitors versus clopidogrel in the EUROMAX trial

Kurt Huber, Gregory Ducrocq, Christian W Hamm, Arnoud van 't Hof, Frédéric Lapostolle, Pierre Coste, Giovanni Gordini, Jacob Steinmetz, Freek W A Verheugt, Jennifer Adgey, Lutz Nibbe, Vojko Kaniĉ, Peter Clemmensen, Uwe Zeymer, Debra Bernstein, Jayne Prats, Efthymios N Deliargyris, Ph Gabriel Steg

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Objective: To ascertain whether different oral P2Y12inhibitors might affect rates of acute stent thrombosis and 30-day outcomes after primary percutaneous coronary intervention (pPCI).

Methods: The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) randomised trial compared prehospital bivalirudin with heparin with optional glycoprotein IIb/IIIa inhibitor treatment in patients with ST-segment elevation myocardial infarction triaged to pPCI. Choice of P2Y12inhibitor was at the investigator's discretion. In a prespecified analysis, we compared event rates with clopidogrel and newer oral P2Y12inhibitors (prasugrel, ticagrelor). Rates of the primary outcome (acute stent thrombosis) were examined as a function of the P2Y12inhibitor used for loading and 30-day outcomes (including major adverse cardiac events) as a function of the P2Y12inhibitor used for maintenance therapy. Logistic regression was used to adjust for differences in baseline characteristics.

Results: Prasugrel or ticagrelor was given as the loading P2Y12inhibitor in 49% of 2198 patients and as a maintenance therapy in 59%. No differences were observed in rates of acute stent thrombosis for clopidogrel versus newer P2Y12inhibitors (adjusted OR 0.50, 95% CI 0.13 to 1.85). After adjustment, no difference was observed in 30-day outcomes according to maintenance therapy except for protocol major (p=0.029) or minor (p=0.025) bleeding and Thrombolysis In Myocardial Infarction minor bleeding (p=0.002), which were less frequent in patients on clopidogrel. Consistent results were observed in the bivalirudin and heparin arms.

Conclusions: The choice of prasugrel or ticagrelor over clopidogrel was not associated with differences in acute stent thrombosis or 30-day ischaemic outcomes after pPCI.

Trial registration number: NCT01087723.

TidsskriftOpen Heart
Udgave nummer2
Antal sider9
StatusUdgivet - 2017

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