@article{a39a529dbeed48f683a2148dc52d8b83,
title = "Prasugrel versus clopidogrel for acute coronary syndromes without revascularization",
abstract = "BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P = 0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P = 0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. CONCLUSIONS: Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.)",
author = "Roe, {Matthew T.} and Armstrong, {Paul W.} and Fox, {Keith A.A.} and White, {Harvey D.} and Dorairaj Prabhakaran and Goodman, {Shaun G.} and Cornel, {Jan H.} and Bhatt, {Deepak L.} and Peter Clemmensen and Felipe Martinez and Diego Ardissino and J. Nicolau and Boden, {William E.} and Gurbel, {Paul A.} and Witold Ruzyllo and Dalby, {Anthony J.} and McGuire, {Darren K.} and Leiva-Pons, {Jose L.} and Alexander Parkhomenko and Shmuel Gottlieb and G. Topacio and Christian Hamm and Gregory Pavlides and A. Goudev and Ali Oto and Tseng, {Chuen Den} and Bela Merkely and Vladimir Gasparovic and Ramon Corbalan and Mircea Cintezǎ and R. McLendon and Winters, {Kenneth J.} and Brown, {Eileen B.} and Yuliya Lokhnygina and Aylward, {Philip E.} and Kurt Huber and Hochman, {Judith S.} and Ohman, {E. Magnus} and {TRILOGY ACS Investigators} and E. Ohman and Bassand, {J. P.} and Castillo, {V. R.} and T. Chua and M. Cinteza and D. Erlinge and Foley, {D. P.} and V. Fridrich and J. Ge and S. Goodman and A. Goudev and N. Gratsiansky and Hamm, {C. W.} and Jeong, {M. H.} and Z. Jun-Ren and J. Lopez-Sendon and T. Luscher and Mogrovejo, {W. E.} and J. Nicolau and B. Petrauskiene and L. Providencia and M. Roe and P. Sritara and M. Syv{\"a}nne and G. Topacio and F. Verheugt and P. Widimsky and Wiviott, {S. D.} and R. Zambahari and {Van de Werf}, F. and A. Budaj and Gersh, {B. J.} and G. Montalescot and Pocock, {S. J.} and Wilcox, {R. G.} and Williams, {D. O.} and M. Wilson and Mehta, {R. H.} and Alexander, {J. H.} and Kong, {D. F.} and R. Lopes and Mahaffey, {K. W.} and C. Melloni and L. Newby and Shah, {B. R.} and P. Tricoci and George, {D. J.} and Beaven, {A. W.} and Blackwell, {K. L.} and Morse, {M. A.} and Onken, {J. E.} and Ready, {N. E.} and Strickler, {J. H.} and S. Zafar and G. Hafley and K. Pieper and S. Stevens and T. Schibler and M. Chan and Chin, {C. T.} and S. Gharacholou and S. Subherwal and R. McLendon and D. Marshall and W. Macias and L. Lenarz and H. Petijean and F. Plat and {van Kranen}, R. and D. Zamoryakhin and J. Albisu and C. Alvarez and M. Amuchastegui and Astesiano, {A. L.} and J. Beloscar and J. Bergallo and J. Bono and A. Bordonava and Botta, {C. E.} and N. Budassi and A. Caccavo and L. Cartasegna and H. Colombo and R. Costello and G. Covelli and {De Valais}, F. and R. Dran and E. Duronto and Forte, {E. H.} and Garcia, {D. F.} and {Garcia Escudero}, A. and M. Hominal and Hrabar, {A. D.} and Iba{\~n}ez, {J. O.} and H. Jure and {Leon de la Fuente}, R. and {Lobo Marquez}, L. and H. Luciardi and H. Luquez and J. Marino and R. Martingano and {Moises Azize}, G. and D. Nul and C. Patocchi and A. Piombo and A. Prado and M. Rodriguez and {Romero Acu{\~n}a}, A. and Scaro, {G. B.} and {Sosa Liprandi}, A. and Varini, {S. D.} and Vigo, {S. J.} and G. Aroney and M. Arstall and A. Blenkhorn and P. Carroll and D. Chew and N. Collins and C. Hammett and A. Lee and M. Marrinan and P. Roberts-Thomson and J. Waites and W. Benzer and I. Lang and A. Podczeck-Schweighofer and P. Baetsl{\'e} and C. Beauloye and {De Tollenaere}, M. and P. Lancellotti and P. Marechal and {Van Dorpe}, A. and D. Albuquerque and {Andrade Lotufo}, P. and M. Ardnt and G. Arminio and {Alves da Cost}, {F. A.} and Baracioli, {L. M.} and {Bertolim Precoma}, D. and {Carvalho Neuenschwander}, F. and {Damiao Gomes Seabra}, M. and {De Souza}, J. and Duda, {N. T.} and Dutra, {O. P.} and A. Feitosa and H. Filho and Finimundi, {H. C.} and M. Gomes and L. Gubolino and Guimar{\~a}es, {A. E.} and M. Hernandes and Jardim, {C. A.} and {Kunz Sebba Barroso de Souza}, W. and Leaes, {P. E.} and Maia, {L. N.} and E. Manenti and {Marin Neto}, {J. A.} and R. Marino and Y. Michalaros and {Mora Junior}, R. and {Moraes Junior}, {J. B.} and {Nogueira Liberato de Sousa}, L. and {Pimentel Filho}, P. and C. Polanczyk and {Rabelo Alves}, A. and R. Ramos and G. Reis and {Rocha Faria Neto}, J. and {Rossi Dos Santos}, F. and W. Saporito and Saraiva, {J. F.} and Sartori, {P. C.} and {Scholz Issa}, J. and {Silva Junior}, D. and A. Sousa and M. Teixeira and Zimmermann, {S. L.} and P. Lazov and M. Tokmakova and K. Penchev and I. Petrov and E. Baldjiev and P. Georgiev and V. Hergeldjieva and A. Manolova and B. Dimov and A. Mihov and G. Pencheva and D. Raev and K. Ramshev and H. Tumbev and M. Tzekova and B. Boichev and A. Kadiiski and T. Devedzhiev and A. Bakbak and J. Berlingieri and J. Burstein and D{\'e}ry, {J. P.} and J. Heath and T. Huynh and S. Kassam and W. Kostuk and R. Labonte and C. Maccallum and S. Nawaz and Quraishi, {A. U.} and M. Senaratne and G. Syan and R. Syan and S. Vizel and P. Castro",
year = "2012",
month = oct,
day = "4",
doi = "10.1056/NEJMoa1205512",
language = "English",
volume = "367",
pages = "1297--1309",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachusetts Medical Society",
number = "14",
}