Author + information
- Gilles Montalescot, MD, PhD∗ (, )
- Jean-Philippe Collet, MD, PhD,
- Patrick Ecollan, MD,
- Leonardo Bolognese, MD,
- Jurrien ten Berg, MD, PhD,
- Dariusz Dudek, MD, PhD,
- Christian Hamm, MD,
- Petr Widimsky, MD, DrSc,
- Jean-François Tanguay, MD,
- Patrick Goldstein, MD,
- Eileen Brown, PhD,
- Debra L. Miller, RN, RCIS,
- LeRoy LeNarz, MD,
- Eric Vicaut, MD, PhD,
- ACCOAST Investigators
- ↵∗Institut de Cardiologie, Pitié-Salpêtriėre University Hospital, 47, Boulevard de l’Hôpital, 75013 Paris, France
To answer the comments of Dr. Nairooz and colleagues, we have performed additional analyses of the percutaneous coronary intervention subgroup that need to be examined with caution considering their post-hoc nature. Although it is possible to evaluate the individual risk of a patient presenting with a non–ST-segment elevation myocardial infarction according to well-known factors or scores, making the decision to pre-treat or not, according to this evaluation does not seem appropriate. The GRACE (Global Registry of Acute Coronary Events) score, defined as high when more than 110, was not associated with lower rates of the primary endpoint at 30 days in patients who were pre-treated with prasugrel (15.66%) versus those who were not (14.08%, p value for interaction = 0.26). This was also confirmed when a GRACE score of more than 140 was considered (15.54 pre-treatment vs. 16.85 no pretreatment, p for interaction = 0.56). The analyses were also consistent according to the presence of ischemic abnormalities on the electrocardiogram (p for interaction = 0.74) or for the presence of ST-segment depression more than 1 mm (p for interaction = 0.97). The results were also consistent at 7 days for all these subgroups.
Stent thrombosis rates were indeed very low and not different between the 2 groups. These results are in line with the TRITON (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel) results and confirm that prasugrel is a very effective drug to prevent stent thrombosis when administered in the catheterization laboratory. The current data on stent thrombosis support further the conclusions that prasugrel does not need to be administered before coronary angiography in NSTEMI patients.
Please note: Dr. Montalescot has received consulting fees from Bayer, Boehringer-Ingelheim, CFR, Europa, GLG, Iroko Cardio International, Lead-Up, LLC, Luminex, Mc Kinsey, Remedica, Servier, TIMI Group, WebMD, and Wolters; consulting fees and grant support from Bristol-Myers Squibb, AstraZeneca, Biotronik, Eli Lilly, The Medicines Company, Medtronic, Menarini, Sanofi, Pfizer, and Accumetrics; and grant support from Abbott Vascular, Daiichi-Sankyo, Nanospheres, and Stentys. Dr. Collet has received research grants from Bristol-Myers Squibb, Sanofi, Eli Lilly, Guerbet Medical, Medtronic, Boston Scientific, Cordis, Stago, Centocor, Fondation de France, INSERM, Federation Francaise de Cardiologie, and Société Française de Cardiologie; consulting fees from Sanofi, Eli Lilly, and Bristol-Myers Squibb; and lecture fees from Bristol-Myers Squibb, Sanofi, and Eli Lilly. Dr. Bolognese has received fees for board membership from Daiichi-Sankyo and Eli Lilly; consulting fees from Daiichi-Sankyo; and lecture fees from Daiichi-Sankyo, Eli Lilly, Menarini, Abbott Vascular, AstraZeneca, and Iroko Cardio International. Dr. ten Berg has received fees for board membership from AstraZeneca; consulting fees from AstraZeneca, Eli Lilly, and Merck; and lecture fees from AstraZeneca and Eli Lilly. Dr. Dudek has received consulting and lecture fees from Abbott Vascular, Adamed, Adyton Medical Polska, Abiomed Europe, AstraZeneca, Biotronik, Balton, Bayer, Braun, BioMatrix, Boston Scientific, Boehringer Ingelheim, Bracco, Bristol-Myers Squibb, Comesa Polska, Cordis, Cook, Covidien Polska, DRG MedTek, Eli Lilly, EuroCor, GE Hammermed Healthcare, GlaxoSmithKline, Inspire-MD, Iroko Cardio International, Medianet, Medtronic, The Medicines Company, Meril Life Sciences, Merck Sharp & Dohme, Orbus-Neich, Pfizer, Possis, ProCardia Medical, Promed, REVA Medical, Sanofi, Siemens, Solvay, Stentys, St. Jude Medical, Terumo, Tyco, and Volcano. Dr. Hamm has received payment for board membership from AstraZeneca, Medtronic, and Boehringer Ingelheim; consulting and lecture fees from Medtronic, Boehringer Ingelheim, Eli Lilly, The Medicines Company, Abbott Vascular, Bayer, Sanofi, Boston Scientific, Correvio, Roche Diagnostics, Pfizer, Cordis, Daiichi-Sankyo, and GlaxoSmithKline; and lecture fees from AstraZeneca and Merck. Dr. Widimsky has received consulting and lecture fees from Eli Lilly and Daiichi-Sankyo. Dr. Tanguay has received consulting fees from Eli Lilly, AstraZeneca, Abbott Vascular, Roche, and GlaxoSmithKline; lecture fees from Eli Lilly, AstraZeneca, Abbott Vascular, Pfizer, and Bristol-Myers Squibb; and grant support from Eli Lilly, AstraZeneca, Abbott Vascular, GlaxoSmithKline, Roche, and Sanofi. Dr. Goldstein has received fees for board membership from Boehringer Ingelheim, The Medicines Company, and Daiichi-Sankyo; consulting fees from Boehringer Ingelheim, Bayer, Sanofi, and AstraZeneca; lecture fees from Boehringer Ingelheim, The Medicines Company, Daiichi-Sankyo, Bayer, Sanofi, and AstraZeneca; payment for the development of educational presentations from Boehringer Ingelheim and AstraZeneca; and travel support from Boehringer Ingelheim, Daiichi-Sankyo, and Sanofi. Drs. Brown, Miller, and LeNarz are employees of and hold stock in Eli Lilly. Dr. Vicaut has received fees for board membership from CERC, consulting fees from Pfizer, Sanofi, LFB, Abbott Vascular, Fresenius, Medtronic, and Hexacath; lecture fees from Novartis; and grant support from Sanofi and Boehringer Ingelheim. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation