TRILOGY ACS Angiographic Cohort Shows ACS Patients Triaged to Medical Therapy Following Angiography Have Lower Rates of CV Events With Prasugrel vs. Clopidogrel

Patients with non-ST-elevation acute coronary syndromes (ACS) triaged to medical therapy following angiography tend to have lower rates of combined endpoint events of cardiovascular death, myocardial infarction, or stroke when treated with prasugrel and compared to clopidogrel, according to results from the TRILOGY ACS Angiographic Cohort, presented by Dr. Stephen Wiviott on Oct. 24 at the TCT 2012 Meeting in Miami, Fl. TRILOGY ACS Angiographic Cohort is a substudy of the TRILOGY ACS trial that was published in Aug. 2012 and presented as part of the ESC Congress 2012.

In addition, study investigators found patients treated with prasugrel have lower rates of myocardial infarction and stroke alone, in addition to lower recurrent ischemic events, and tend to have higher rates of thrombolysis in myocardial infarction (TIMI) major bleeding when compared to clopidogrel.

Results also showed that substantial differences in baseline characteristics exist among patients triaged for medical therapy with or without angiography. Patients from North America, Western Europe, Australia, South Africa and the Mediterranean region had higher rates of angiography. Further, patients with angiography more often were enrolled with non-ST segment myocardial infarction (NSTEMI) and had prior history of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG).

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Since the TRILOGY ACS trial found that use of prasugrel did not reduce adverse cardiovascular outcomes in patients with non-ST-elevation ACS selected for medical management without revascularization, the cohort aimed to assess clinical characteristics and outcomes of subjects triaged to medical therapy with or without preceding angiography and to assess the effects of prasugrel vs. clopidogrel in these two groups and whether there was any differentiation effect based on how subjects entered the trial.

The investigators conclude that their results are consistent with previous trials and suggest that "when angiography is performed and coronary disease is confirmed, the benefits and risks of intensive antiplatelet therapy exist whether medical therapy or PCI is elected."

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