Mortality in primary angioplasty patients starting antiplatelet therapy with prehospital prasugrel or clopidogrel: a 1-year follow-up from the European MULTIPRAC Registry

Abstract

Aim

MULTIPRAC was designed to provide insights into the use and outcomes associated with prehospital initiation of antiplatelet therapy with either prasugrel or clopidogrel in the context of primary percutaneous coronary intervention. After a previous report on efficacy and safety outcomes during hospitalization, we report here the 1-year follow-up data, including cardiovascular (CV) mortality.

Methods and results

MULTIPRAC is a multinational, prospective registry of patients with ST-elevation myocardial infarction (STEMI) from 25 hospitals in nine countries, all of which had an established practice of prehospital start of dual antiplatelet therapy in place. The key outcome was CV death at 1 year. Among 2,036 patients followed-up through 1 year, 49 died (2.4%), 10 during the initial hospitalization and 39 within 1 year after hospital discharge. The primary analysis was based on the P2Y₁₂-inhibitor, used from prehospital loading dose through hospital discharge. Prasugrel (n=824) was more commonly used than clopidogrel (n=425). The observed 1-year rates for CV death were 0.5% with prasugrel and 2.6% with clopidogrel. After adjustment for differences in baseline characteristics, treatment with prasugrel was associated with a significantly lower risk of CV death than treatment with clopidogrel (odds ratio 0.248; 95% confidence interval 0.06–0.89).

Conclusion

In STEMI patients from routine practice undergoing primary angioplasty, who were able to start oral antiplatelet therapy prehospital, treatment with prasugrel as compared to clopidogrel was associated with a lower risk of CV death at 1-year follow-up.

Keywords:

• upstream treatment
• P2Y₁₂-inhibitor
• dual antiplatelet therapy
• primary percutaneous coronary intervention
• observational

Acknowledgments

We thank all participating patients and staff, including the doctors and nurses who made this study possible. Further, we are thankful to Josef Schmitt for statistical analyses. Editorial assistance in the preparation of the manuscript was provided by 3P Consulting, Seefeld, Germany, and paid for by Daiichi Sankyo Europe GmbH.

Disclosure

MULTIPRAC was sponsored by Daiichi-Sankyo Europe GmbH and Eli Lilly and Company. The MULTIPRAC steering committee members, Patrick Goldstein, France (chair), Peter Clemmensen, Denmark (co-chair); Nicolas Danchin, France; Hüseyin Ince, Germany; and Niccolo Grieco, Italy, received study honoraria, travel expenses, or consulting fees from Daiichi-Sankyo and Eli Lilly.

Peter Clemmensen received consulting, speaker fees, and research grants from Abbott, AstraZeneca, Aventis, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Eli-Lilly, Evolva, Fibrex, Janssen, Merck, Myogen, Medtronic, Mitsubishi Pharma, The Medicines Company, Nycomed, Organon, Pfizer, Pharmacia, Regado, Sanofi, Searle, and Servier.

Nicolas Danchin has received research grants from Amgen, Astra-Zeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, Merck, Novartis, Pfizer, Sanofi-Aventis, Servier, and The Medicines Company and fees for lectures or consulting for Amgen, Astra-Zeneca, Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi-Sankyo, Eli-Lilly, GlaxoSmithKline, MSD-Schering, Novartis, Novo-Nordisk, Pfizer, Roche, Sanofi-Aventis, Servier, and The Medicines Company.

Yvonne Ramos is an employee of Daiichi-Sankyo Europe GmbH.

Jochen Goedicke is an employee of Lilly Deutschland GmbH. The authors report no other conflicts of interest in this work.