A study has found that the anti-clotting medication prasugrel reduced cardiovascular events among patients who present with an acute coronary syndrome and are managed medically after an angiogram is performed to determine coronary anatomy. Results of the TRILOGY ACS trial, Angiographic Cohort were presented today at the 24th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium. Sponsored by the Cardiovascular Research Foundation (CRF), TCT is the world's premier educational meeting specializing in interventional cardiovascular medicine.
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 platelet inhibitor is beneficial in patients with unstable angina (UA) or non-ST segment elevation myocardial infarction (NSTEMI). Because a substantial fraction of these patients do not undergo revascularization after angiography, their optimal DAPT strategy is unknown.
The TRILOGY ACS trial compared prasugrel with aspirin versus clopidogrel with aspirin in the primary cohort of 7,243 UA/NSTEMI patients less than 75 years old who were medically managed without revascularization and had at least one high-risk criterion. The primary results of this study, presented at the European Society of Cardiology earlier this year, did not show any benefit for prasugrel with aspirin versus clopidogrel.
Patients were enrolled in 52 countries from June 2008 through September 2011 with median follow-up of 17 months. Those who weighed more than 60 kg were treated with a 10 mg maintenance dose of prasugrel versus 75 mg of clopidogrel; patients less than 60 kg received 5 mg of prasugrel.
Angiography was not required for enrollment, but if performed, evidence of coronary disease had to be demonstrated (at least one lesion > 30 percent stenosis or prior percutaneous coronary intervention/ coronary artery bypass graft surgery). Approximately 43% of the patients had angiography performed and coronary anatomy determined before being triaged to medical therapy. The results of this angiographic cohort were presented for the first time today at TCT.
Overall, in the TRILOGY ACS Trial, prasugrel did not reduce cardiovascular events among patients managed medically for ACS.