Thrombotic risk in patients with acute coronary syndromes discharged on prasugrel or clopidogrel: results from the PROMETHEUS study
Primary result · MACEResult — go to the resultHazard ratio 1.85 95% CI 1.71–2.00Authors' conclusion
High thrombotic risk, as defined by the 2020 ESC NSTE-ACS guidelines, is highly prevalent among ACS patients undergoing PCI. The HTR definition had a strong prognostic impact, as it successfully identified patients at increased 1 year risk of ischaemic events.
Study context
- Population
- ACS patients undergoing percutaneous coronary intervention (PCI) discharged on prasugrel or clopidogrel
- Participants
- 16,065 patients
- Comparison
- High thrombotic risk vs low-to-moderate thrombotic risk; prasugrel vs clopidogrel by thrombotic risk
- High thrombotic risk (HTR)n = 4,293
- Low-to-moderate thrombotic riskn = 11,772reference
- Primary endpoint
- MACE:
- Death
- MI
- Stroke
- Unplanned revascularization
- Follow-up
- 1 year
Methodological detailsmulticentre, propensity score stratification
- Multicentre
- Propensity score stratification
Primary result
MACE
Hazard ratio
1.85
95% CI 1.71–2.00
P < 0.001
By group
HTR
23.3
%
Low-to-moderate risk
13.6%
HTRvs Low-to-moderate risk
HR 1.85 (95% CI 1.71–2.00); P < 0.001
As reported in the abstract
- HTR prevalence
- 26.7%
Further findings
| Outcome | adjHR (95% CI) | |
|---|---|---|
| MACE, prasugrel vs clopidogrel, by thrombotic risk (subgroup) · 1 yearPrasugrelvs ClopidogrelHTR | 0.83 (0.68–1.02) | |
| MACE, prasugrel vs clopidogrel, by thrombotic risk (subgroup) · 1 yearPrasugrelvs ClopidogrelLow-to-moderate risk | 0.75 (0.64–0.88) | |
| 0.512Adjusted hazard ratio (log scale) |
- Major adverse cardiac events (MACE), prasugrel vs clopidogrel, by thrombotic risk (subgroup): pinteraction = 0.32
Original publication
Thrombotic risk in patients with acute coronary syndromes discharged on prasugrel or clopidogrel: results from the PROMETHEUS study. Eur Heart J Acute Cardiovasc Care. Published 18 July 2023. doi:10.
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