Coronary Artery Disease Clinical Trial
Official title:
Assessment of Loading With the P2Y12 Inhibitor Ticagrelor or Clopidogrel to Halt Ischemic Events in Patients Undergoing Elective Coronary Stenting: The ALPHEUS Study
The new P2Y12 inhibitors prasugrel (Efient®-Effient®) and ticagrelor (Brilique®-Brilinta®)
have shown promising results in the respective TRITON and PLATO trials making of prasugrel
and ticagrelor recommended first line treatments for acute coronary syndrome ACS (ESC
Guidelines: Class 1 LOE B). These two drugs showed superiority over clopidogrel in ACS
patients undergoing percutaneous coronary intervention (PCI), by the dramatic diminution of
stent thrombosis, the reduction in death or Myocardial Infarction (MI) as well as the
reduction in death in a meta-analysis.
The field of elective PCI (stable patients) has not been studied with these 2 new drugs and
clopidogrel remains the standard of care. However, off-label use of prasugrel and ticagrelor
is increasing in patients undergoing high risk elective PCI (left main, diabetics, multiple
stenting, high risk of stent thrombosis, no clopidogrel pretreatment…) but is not supported
by scientific evidence. More than half of PCI patients undergo elective stenting for proven
ischemia and/or stable angina, a relatively safe procedure with the use of the latest
generation of stents. However complications remain either frequent when considering
PCI-related myonecrosis/myocardial injury that have been linked to the prognosis of patients
or rare but serious when considering stent thrombosis, Q wave MI or stroke, leaving room for
improvement with these two newest drugs.
The investigators propose to perform a multicenter international study in stable patients
undergoing elective PCI with a randomization between clopidogrel and ticagrelor. The
investigators hypothesize that this study will show superiority of the new P2Y12 inhibitor
over clopidogrel in elective PCI on the primary ischemic endpoint (peri-procedural MI and
myocardial injury) without significant excess bleeding (BARC definition).
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