Impact of low-dose prasugrel on platelet reactivity and cardiac dysfunction in acute coronary syndrome patients requiring primary drug-eluting stent implantation: A randomized comparative study.
OBJECTIVE
The aim of this study was to compare how prasugrel and clopidogrel affect platelet aggregation reactivity, cardiac enzyme release, cardiac remodeling, and the formation of in-stent thrombi after primary percutaneous coronary intervention (PCI).


BACKGROUND
The advantages of using prasugrel over clopidogrel in cardiac injury following acute coronary syndrome (ACS) remain unclear.


METHODS
A total of 78 ACS patients were randomly allocated into clopidogrel (300 mg loading/75 mg maintenance) or prasugrel (20 mg loading/3.75 mg maintenance) treatment groups, followed by undergoing primary PCI. Platelet reactivity and cardiac enzymes were measured before and after primary PCI. Moreover, cardiac function was measured by ultrasound echocardiography and coronary angioscopic observation was after primary PCI up to 8 months later.


RESULTS
Antiplatelet reactivity in the prasugrel treatment group reached optimal levels (P2Y12 reaction units [PRU] less than 262) immediately after the administration and was maintained even at 8 months, independently of the CYP2C19 genotype. Prasugrel treatment significantly suppressed creatine kinase elevation compared to clopidogrel treatment (median value 404 IU/L to 726 IU/L vs. 189 IU/L to 1,736 IU/L, p = 0.018 for maximum values) and reduced left ventricular mass (217.2-168.8 g in prasugrel, p = 0.045; 196.9-176.4 g in clopidogrel, p = 0.061). There were no significant differences in the incidence of in-stent attached thrombi between the two groups.


CONCLUSIONS
Compared to clopidogrel, prasugrel produced a stable platelet aggregation inhibitory effect in patients with ACS regardless of CYP2C19 genotype, reduced cardiac enzyme release, and prevented cardiac remodeling after ACS.
['Kitano|Daisuke|D|', 'Takayama|Tadateru|T|', 'Fukamachi|Daisuke|D|', 'Migita|Suguru|S|', 'Morikawa|Tomoyuki|T|', 'Tamaki|Takehiro|T|', 'Kojima|Keisuke|K|', 'Mineki|Takashi|T|', 'Murata|Nobuhiro|N|', 'Akutsu|Naotaka|N|', 'Sudo|Mitsumasa|M|', 'Hiro|Takafumi|T|', 'Hirayama|Atsushi|A|', 'Okumura|Yasuo|Y|']
D054058:Acute Coronary Syndrome D000368:Aged D000077144:Clopidogrel D003328:Coronary Thrombosis D065731:Cytochrome P-450 CYP2C19 D054855:Drug-Eluting Stents D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D062645:Percutaneous Coronary Intervention D000071184:Pharmacogenomic Variants D010974:Platelet Aggregation D010975:Platelet Aggregation Inhibitors D000068799:Prasugrel Hydrochloride D011446:Prospective Studies D058921:Purinergic P2Y Receptor Antagonists D012307:Risk Factors D013997:Time Factors D014041:Tokyo D016896:Treatment Outcome D016277:Ventricular Function, Left D020257:Ventricular Remodeling
prasugrel cardiac dysfunction acute coronary syndrome cardiac enzyme CYP2C19