Use of prasugrel vs clopidogrel and outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention in contemporary clinical practice: Results from the PROMETHEUS study
Use of prasugrel vs clopidogrel and outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention in contemporary clinical practice: Results from the PROMETHEUS study
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DOI：
10.1016/j.ahj.2017.02.013
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发表时间：
2017-06-01
影响因子：
4.8
通讯作者：
Mehran, Roxana
中科院分区：
文献类型：
--
作者：
Haber, Usman;Sartori, Samantha;Mehran, Roxana
背景和目的：我们试图确定普拉格雷和急性冠脉综合征患者接受经皮冠状动脉介入治疗（PCI）在临床practice.Methods的结果之间的使用频率和关联PROMETHEUS是一个多中心的观察注册急性冠脉综合征患者接受PCI从8个中心在美国，保持一个前瞻性PCI注册患者的结果。主要终点是90天时的主要不良心血管事件，包括全因死亡、非致死性心肌梗死、卒中或计划外血运重建。大出血定义为需要住院或输血的任何出血。采用多变量考克斯回归分析得出风险比（HR），并根据普拉格雷治疗倾向进行分层。结果在19，914例患者中（平均年龄64.4岁，32%为女性），4，058例接受普拉格雷治疗（20%），15，856例接受氯吡格雷治疗（80%）。与接受氯吡格雷治疗的患者相比，接受普拉格雷治疗的患者更年轻，共病风险因素更少。在90天时，普拉格雷的使用与较低的主要不良心血管事件之间存在显著相关性（5.7% vs 9.6%，HR 0.58，95% CI 0.50-0.67，P
Background and objectives We sought to determine the frequency of use and association between prasugrel and outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI) in clinical practice.Methods PROMETHEUS was a multicenter observational registry of acute coronary syndrome patients undergoing PCI from 8 centers in the United States that maintained a prospective PCI registry for patient outcomes. The primary end points were major adverse cardiovascular events at 90 days, a composite of all-cause death, nonfatal myocardial infarction, stroke, or unplanned revascularization. Major bleeding was defined as any bleeding requiring hospitalization or blood transfusion. Hazard ratios (HRs) were generated using multivariable Cox regression and stratified by the propensity to treat with prasugrel.Results Of 19,914 patients (mean age 64.4 years, 32% female), 4,058 received prasugrel (20%) and 15,856 received clopidogrel (80%). Prasugrel-treated patients were younger with fewer comorbid risk factors compared with their counterparts receiving clopidogrel. At 90 days, there was a significant association between prasugrel use and lower major adverse cardiovascular event (5.7% vs 9.6%, HR 0.58, 95% CI 0.50-0.67, P