Author + information
- Ramez Nairooz, MD∗ (, )
- Partha Sardar, MD and
- Wilbert S. Aronow, MD
- ↵∗Division of Cardiology, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 532, Little Rock, Arkansas 72205-7199
We commend the authors of the recently published ACCOAST-PCI (A Comparison of Prasugrel at the Time of Percutaneous Coronary Intervention or as Pre-treatment At the Time of Diagnosis in Patients with Non-ST-Elevation Myocardial Infarction) study (1) for their efforts. Despite being the largest randomized trial of pre-treatment with prasugrel in non–ST-segment elevation myocardial infarction (NSTEMI) patients, we have reservations that we detail as follows.
Risk stratification for adverse cardiac events is a key component of treating NSTEMI patients. In this trial, ∼57% of patients presented with ischemic ST-segment changes and ∼23% with a GRACE (Global Registry of Acute Coronary Events) score of more than 140. It would be interesting to know the event rates in these patients stratified according to whether they were pre-treated with prasugrel or not. Ischemic events are higher in patients with ischemic ST-segment changes and/or high GRACE score, which may warrant more aggressive therapy to improve outcomes (2).
The event rates for stent thrombosis were extremely low, <0.5%. Because the trial was not powered to show the differences between both strategies, no real conclusions can be drawn about stent thrombosis and the association with pre-treatment with prasugrel other than numerically there were fewer events in the pre-treatment group.
- American College of Cardiology Foundation
- Montalescot G.,
- Collet J.P.,
- Ecollan P.,
- et al.,
- for the ACCOAST Investigators
- Amsterdam E.A.,
- Wenger N.K.,
- Brindis R.G.,
- et al.