In new guidelines from the European Society of Cardiology (ESC), Prasugrel – a once daily oral antiplatelet medicine – received a Class I recommendation for use in patients undergoing percutaneous coronary intervention (PCI) after experiencing a non-ST-segment elevation acute coronary syndrome (which comprises non-ST segment elevation myocardial infarction or NSTEMI – a type of heart attack – and unstable angina or UA

-Team@CMHF

• The Guidelines Committee endorsed the use of Prasugrel in UA/NSTEMI patients (especially those with diabetes) who are Clopidogrel naive in whom coronary anatomy is known and who are proceeding to PCI.
• UA and NSTEMI patients are at high risk of cardiovascular events, and they often represent a challenge in clinical practice.
• There is a significant body of evidence which showed that Prasugrel can form part of an appropriate management strategy to minimize risk for these patients
• The guidelines, based on the latest clinical evidence, set out clear recommendations that offer alternative treatment options, such as Prasugrel, for treating some of these high risk patients.
• In the updated guidelines – titled Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation – Prasugrel was recommended regardless of a patient’s genetic status, and the guidelines state Prasugrel does not appear to be affected by CYP inhibitors, including proton pump inhibitors.
• NSTEMI and UA accounts for about 2.5 million hospital admissions worldwide each year.
• In developed countries NSTEMI is the most frequent type of ACS and represents the largest group of patients undergoing PCI.
• Despite advances in medical and interventional treatments, the mortality and morbidity remain high and equivalent to that of patients with severe heart attacks (known as STEMI) after the initial month.
• However, patients with NSTEMI constitute a heterogeneous group of patients with a highly variable prognosis.
• Therefore, early risk stratification is essential for selection of medical as well as interventional treatment strategies.
• This new recommendation is based on the clinical evidence for Prasugrel in UA/NSTEMI patient population in the TRITON-TIMI 38 study, which led to a level of evidence ‘B’ (‘data derived from a single randomized clinical trial’).
• In the TRITON-TIMI 38 study, which included 10,074 patients with chest pain at rest (UA) or experiencing NSTEMI (74 percent of the study population), treatment with Prasugrel produced a statistically significant 18 percent reduction in the relative risk of the combined endpoint of cardiovascular death, nonfatal heart attack or nonfatal stroke compared with Clopidogrel.
• In this patient population, the incidence of non-CABG-related TIMI major (2.2 percent with Prasugrel vs. 1.6 percent with Clopidogrel) and minor (2.3 percent with Prasugrel and 1.6 percent with Clopidogrel) bleeding was statistically significantly higher in patients treated with Prasugrel compared to Clopidogrel.

About Prasugrel

• Prasugrel is an oral antiplatelet agent which helps keep blood platelets from clumping together and developing a blockage in an artery.
• To date Prasugrel has been approved in more than 65 countries worldwide

About Acute Coronary Syndromes

• Acute coronary syndrome includes heart attacks and unstable angina (chest pain).
• Coronary heart disease, which can result in ACS, lead to more than 741,000 deaths in the EU each year.
• In addition, ACS affects more than one million people in the United States annually.
• Heart attack is a major manifestation of coronary heart disease, which occurs when the arteries become narrowed or clogged by cholesterol and fat deposits. In some cases the plaque can rupture, resulting in a blood clot, which may partially or totally block the blood supply to portions of the heart, resulting in ACS.
• Many ACS patients undergo PCI to re-open the artery, which usually includes a stent placement.

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