Abstract 12897: Switch and Non Switch Between Thienopyridines: Impact of the Real-Life Use of Clopidogrel and Prasugrel on Outcomes in Acute Myocardial Infarction. Insights from the Fast MI 2010 Registry
Background: In patients(pts) with AMI, when initial clopidogrel treatment seems sub-optimal, switching to prasugrel seems attractive. We assessed characteristics and outcomes in prasugrel-treated pts, according to the initial use of clopidogrel before prasugrel.
Methods: FAST-MI 2010 is a nationwide French registry. In total, 4115 received thienopyridines, of whom 1259(31%) received prasugrel. Among these, 391 received "de novo" prasugrel (G1), 807 (64%) were treated with clopidogrel first and then switched to prasugrel (G2). We compared baseline characteristics, bleeding and ischemic complications between G1 & G2, and used propensity-score matching (propensity to be treated with prasugrel) to compare outcomes in 2 cohorts.
Results: Age and sex were similar in G1 and G2; more G2 pts had a history of AMI (13% vs 8%, P=0.01), PCI (14% vs 9.5%, P=0.02), underwent PCI during the hospital stay (96% vs 93%, P=0.047) or received lytic treatment for STEMI (21% vs 5%, P<0.001). With the exception of major bleeding, which was less frequent in G2 (0 vs 1.0%, P=0.004), none of the other complications differed significantly (Table). The 2 propensity-score matched cohorts (316 patients each) had completely similar baseline characteristics and 96% (switch clopidogrel to prasugrel) vs 94% (prasugrel only) followed the recommended indication for prasugrel use; none of the complications differed significantly (switch vs no switch): any bleeding (4.1 vs 6.6%), major bleeding (0 vs 0.3%), stent thrombosis (1.3 vs 0.9%), stroke (0.3 vs 0%), reinfarction (1.3 vs 0.6%), in-hospital death (0.3 vs 0.3%).
Conclusion: In this registry, a high proportion of prasugrel-treated pts were switched from clopidogrel (64%). There was no evidence of excess risk of bleeding or in-hospital complications in pts who were switched, vs those receiving prasugrel only. Randomized studies are needed to determine safety and efficacy of this strategy.
- © 2012 by American Heart Association, Inc.