Prasugrel-based De-Escalation of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With STEMI
- Author:
You-Jeong KI
1
;
Bong Ki LEE
;
Kyung Woo PARK
;
Jang-Whan BAE
;
Doyeon HWANG
;
Jeehoon KANG
;
Jung-Kyu HAN
;
Han-Mo YANG
;
Hyun-Jae KANG
;
Bon-Kwon KOO
;
Dong-Bin KIM
;
In-Ho CHAE
;
Keon-Woong MOON
;
Hyun Woong PARK
;
Ki-Bum WON
;
Dong Woon JEON
;
Kyoo-Rok HAN
;
Si Wan CHOI
;
Jae Kean RYU
;
Myung Ho JEONG
;
Kwang Soo CHA
;
Hyo-Soo KIM
;
On behalf of the HOST-RP-ACS investigators
Author Information
- Publication Type:Original Research
- From:Korean Circulation Journal 2022;52(4):304-319
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background and Objectives:De-escalation of dual-antiplatelet therapy through dose reduction of prasugrel improved net adverse clinical events (NACEs) after acute coronary syndrome (ACS), mainly through the reduction of bleeding without an increase in ischemic outcomes. Whether the benefits of de-escalation are sustained in highly thrombotic conditions such as ST-elevation myocardial infarction (STEMI) is unknown. We aimed to assess the efficacy and safety of de-escalation therapy in patients with STEMI or non-STsegment elevation ACS (NSTE-ACS).
Methods:This is a pre-specified subgroup analysis of the HOST-REDUCE-POLYTECH-ACS trial. ACS patients were randomized to prasugrel de-escalation (5 mg daily) or conventional dose (10 mg daily) at 1-month post-percutaneous coronary intervention. The primary endpoint was a NACE, defined as a composite of all-cause death, non-fatal myocardial infarction, stent thrombosis, clinically driven revascularization, stroke, and bleeding events of grade ≥2 Bleeding Academic Research Consortium (BARC) criteria at 1 year.
Results:Among 2,338 patients included in the randomization, 326 patients were diagnosed with STEMI. In patients with NSTE-ACS, the risk of the primary endpoint was significantly reduced with de-escalation (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.48– 0.89; p=0.006 for de-escalation vs. conventional), mainly driven by a reduced bleeding. However, in those with STEMI, there was no difference in the occurrence of the primary outcome (HR, 1.04; 95% CI, 0.48–2.26; p=0.915; p for interaction=0.271).
Conclusions:Prasugrel dose de-escalation reduced the rate of NACE and bleeding, without increasing the rate of ischemic events in NSTE-ACS patients but not in STEMI patients.
