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Prasugrel comparado con clopidogrel en pacientes sometidos a intervención coronaria percutánea para el infarto de
Gilles Montalescot1, Stephen D Wiviott, Eugene Braunwald
1Institute of Cardiology, INSERM U856, Université Paris 6, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
Lancet (London, England)
|March 3, 2009
Resumen
El prasugrel redujo significativamente los eventos isquémicos en pacientes con infarto de miocardio de elevación ST (STEMI) sometidos a intervención coronaria percutánea (PCI) en comparación con el clopidogrel. Esta potente terapia antiplaquetaria mostró una mejora de la eficacia sin un aumento significativo en los eventos de sangrado mayor.
Área de la Ciencia:
- Cardiología Cardiología.
- Farmacología Farmacología.
Sus antecedentes:
- La gestión del infarto de miocardio de elevación ST (STEMI) a menudo implica una reperfusión mecánica con stenting.
- La terapia antiplaquetaria dual, típicamente aspirina y clopidogrel, es el tratamiento estándar después de la ICP.
- El prasugrel ofrece una alternativa potente y de acción rápida al clopidogrel.
Objetivo del estudio:
- Para comparar la eficacia y seguridad de prasugrel frente a clopidogrel en pacientes con STEMI sometidos a PCI.
- Evaluar el prasugrel como una alternativa potencial al clopidogrel en esta población de pacientes.
Principales métodos:
- Un ensayo controlado aleatorizado doble ciego que involucró a 3534 pacientes con STEMI en 707 sitios en 30 países.
- Los participantes recibieron ya sea prasugrel (60 mg de carga, 10 mg de mantenimiento) o clopidogrel (300 mg de carga, 75 mg de mantenimiento).
- Endpoint primario: compuesto de muerte cardiovascular, infarto de miocardio no fatal o accidente cerebrovascular no fatal, evaluado hasta 15 meses.
Principales resultados:
- El prasugrel redujo significativamente el objetivo primario a los 30 días (6,5% vs 9,5%, p=0,0017) y a los 15 meses (10,0% vs 12,4%, p=0,0221).
- Los puntos finales secundarios clave, incluida la revascularización urgente del vaso objetivo y la trombosis del stent, también se redujeron significativamente con prasugrel.
- No se observó ninguna diferencia significativa en el sangrado mayor no relacionado con la cirugía CABG entre los grupos; sin embargo, el sangrado mayor después de la CABG aumentó con prasugrel.
Conclusiones:
- El prasugrel demuestra una eficacia superior al clopidogrel en la prevención de eventos isquémicos en pacientes con STEMI sometidos a ICP.
- El estudio sugiere que el prasugrel es una opción más efectiva para los pacientes con STEMI, con un perfil de riesgo de sangrado general comparable, excepto para el sangrado post-CABG.
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