Intensified Versus Standard Loading Strategies Before Elective Percutaneous Coronary Interventions - SASSICAIA

Sep 02, 2019
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Date Presented:
09/02/2019
Original Posted Date:
09/02/2019
References

Contribution To Literature:

The SASSICAIA trial failed to show that prasugrel loading was superior in elective PCI.

Description:

The goal of the trial was to evaluate prasugrel compared with clopidogrel among patients undergoing elective percutaneous coronary intervention (PCI).

Study Design

  • Randomized
  • Parallel

Patients with stable coronary disease undergoing elective PCI were randomized to loading with prasugrel (n = 382) versus clopidogrel (n = 399). After PCI, all patients were maintained on clopidogrel.

  • Total number of enrollees: 781
  • Duration of follow-up: 30 days

Inclusion criteria:

  • Stable coronary disease
  • Undergoing elective PCI

Principal Findings:

The trial was terminated early due to slow enrollment.

The primary outcome of all-cause death, any myocardial infarction, definite/probable stent thrombosis, stroke, or urgent vessel revascularization at 30 days occurred in 17.3% in the prasugrel group compared with 18.6% of the clopidogrel group (p = 0.64).

Secondary outcomes:

  • Any myocardial infarction: 16.2% in the prasugrel group compared with 17.5% of the clopidogrel group (p = 0.64)
  • Bleeding Academic Research Consortium (BARC) ≥2 bleeding: 4.2% in the prasugrel group compared with 4.8% of the clopidogrel group (p = 0.70)

Interpretation:

Among stable patients undergoing elective PCI, loading with prasugrel was not superior to loading with clopidogrel. Although this trial was terminated prematurely, it is unlikely that continuation would have demonstrated a difference between groups. 

References:

Presented by Dr. Julinda Mehilli at the European Society of Cardiology Congress, Paris, France, September 2, 2019.

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Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Cardiac Surgery and SIHD, Interventions and Coronary Artery Disease

Keywords: ESC Congress, ESC 19, Angina Pectoris, Coronary Artery Disease, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention, Stents, Stroke, Thrombosis


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