Un extenso registro de Gran Breta\u00f1a muestra nuevamente los beneficios del Prasugrel sobre Ticagrelor y Clopidogrel en pacientes con infarto agudo del miocardio supra ST y tratados con angioplastia primaria.
\nAnte la ausencia casi definitiva de datos randomizados v\u00e1lidos, \u00bfdeber\u00e1n incorporarse todas estas evidencias de registros observacionales prospectivos en las gu\u00edas de tratamiento?<\/p>\n
Abstract<\/strong> METHODS:<\/strong> RESULTS:<\/strong> CONCLUSIONS:<\/strong>
\nOBJECTIVES:<\/strong>
\nPrasugrel and ticagrelor both reduce ischaemic endpoints in high-risk acute coronary syndromes, compared with clopidogrel. However, comparative outcomes of these two newer drugs in the context of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) remains unclear. We sought to examine this question using the British Cardiovascular Interventional Society national database in patients undergoing primary PCI for STEMI.<\/p>\n
\nData from January 2007 to December 2014 were used to compare use of P2Y12 antiplatelet drugs in primary PCI in >89\u2009000 patients. Statistical modelling, involving propensity matching, multivariate logistic regression (MLR) and proportional hazards modelling, was used to study the association of different antiplatelet drug use with all-cause mortality.<\/p>\n
\nIn our main MLR analysis, prasugrel was associated with significantly lower mortality than clopidogrel at both 30\u2009days (OR 0.87, 95%\u2009CI 0.78 to 0.97, P=0.014) and 1\u2009year (OR 0.89, 95%\u2009CI 0.82 to 0.97, P=0.011) post PCI. Ticagrelor was not associated with any significant differences in mortality compared with clopidogrel at either 30\u2009days (OR 1.07, 95%\u2009CI 0.95 to 1.21, P=0.237) or 1\u2009year (OR 1.058, 95%\u2009CI 0.96 to 1.16, P=0.247). Finally, ticagrelor was associated with significantly higher mortality than prasugrel at both time points (30\u2009days OR 1.22, 95%\u2009CI 1.03 to 1.44, P=0.020; 1\u2009year OR 1.19 95%\u2009CI 1.04 to 1.35, P=0.01).<\/p>\n
\nIn a cohort of over 89\u2009000 patients undergoing primary PCI for STEMI in the UK, prasugrel is associated with a lower 30-day and 1-year mortality than clopidogrel and ticagrelor. Given that an adequately powered comparative randomised trial is unlikely to be performed, these data may have implications for routine care.<\/p>\n