ST Elevation Myocardial Infarction Clinical Trial
Official title:
Comparison of Prasugrel vs. Ticagrelor on Myocardial Injury in Revascularized ST Elevation Acute Myocardial Infarction Patients
The investigators propose to perform a randomized clinical trial comparing prasugrel vs. ticagrelor in 60 patients with ST elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. The principal objective of the study would be analyzing the difference in myocardial infarction size measured by cardiac magnetic resonance at 6 months
Dual antiplatelet therapy consisting of aspirin and one of the P2Y12 receptor inhibitors is
the mainstay of treatment for patients with ST elevation acute myocardial infarction
undergoing primary percutaneous coronary intervention. Prasugrel or ticagrelor have actually
shown to be superior to clopidogrel improving the prognosis of these patients. However, the
industrial interest has avoided any direct comparison between these two antiplatelets.
Comparison is of great interest considering that only ticagrelor has shown to significantly
reduce mortality. As ticagrelor may exert off-target effects through adenosine-related
mechanisms, the investigators aimed to investigate whether ticagrelor reduces myocardial
injury to a greater extent than prasugrel in patients with revascularized STEMI.
Patients with acute STEMI undergoing primary percutaneous coronary revascularization within 6
hours of chest pain, will be randomized to (1) prasugrel (a 60 mg oral loading and a 10-mg
dailiy maintenance dose) or to (2) ticagrelor (a 180 mg loading dose and a 90 mg twice daily
maintenance dose). The predefined primary end point is infarct sieze on magnetic resonance
imaging at the end of the study (6 months). Magnetic resonance will be performed at day 1,
day 7 and moth 6. Platelet reactivity, biomarkers and clinical outcomes will also be assesed.
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