Early and Late Benefits of Prasugrel in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary InterventionA TRITON–TIMI 38 (TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel–Thrombolysis In Myocardial Infarction) Analysis
Elliott M. Antman, MD, FACC*,*,
Stephen D. Wiviott, MD*,
Sabina A. Murphy, MPH*,
Juri Voitk, MD, FACC ,
Yonathan Hasin, MD ,
Petr Widimsky, MD, DrSc ,
Harish Chandna, MBBS, FACC¶,
William Macias, MD, PhD||,
Carolyn H. McCabe, BS* and
Eugene Braunwald, MD, MACC*
* Brigham and Women's Hospital, Boston, Massachusetts
North Estonian Regional Hospital, Tallinn, Estonia
The Kittner and Davidai Institute of Cardiology Center, Poriya, Israel
Cardiocenter, Charles University and University Hospital Vinohrady, Prague, Czech Republic
¶ Detar Hospital, Victoria, Texas
|| Eli Lilly Research Laboratories, Indianapolis, Indiana.
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Figure 1 Landmark Analyses of Efficacy
Landmark analyses (survival method) of the Kaplan-Meier estimates of myocardial infarction (MI), stent thrombosis, and urgent target vessel revascularization (uTVR) during the first 3 days after randomization (left side of each panel) and from 3 days to the end of the study (right side of each panel) are shown for the prasugrel and clopidogrel groups. There were significant reductions in the hazard ratio (HR) for each end point both during the first 3 days and from 3 days to the end of the study that were consistent with independent superiority of the loading and maintenance doses of prasugrel compared with clopidogrel.
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Figure 2 Landmark Analyses of Safety and Net Clinical Benefit
Landmark analyses (survival method) of the Kaplan-Meier estimates of Thrombolysis In Myocardial Infarction major noncoronary artery bypass grafting bleeding and net clinical benefit during the first 3 days after randomization (left side of each panel) and from 3 days to the end of the study (right side of each panel) are shown for the prasugrel and clopidogrel groups. There was no significant increase in major bleeding with prasugrel during the first 3 days, but there was a significant increase from 3 days to the end of the study. Net clinical benefit favored prasugrel during both the early and late phases of the study. HR = hazard ratio.
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