Details

Autor(en) / Beteiligte

• Wilschut, Jeroen M
• Vogel, Rosanne F
• Elscot, Jacob J
• Delewi, Ronak
• Lemmert, Miguel E
• van der Waarden, Nancy W P L
• Nuis, Rutger-Jan
• Paradies, Valeria
• Alexopoulos, Dimitrios
• Zijlstra, Felix
• Montalescot, Gilles
• Angiolillo, Dominick J
• Krucoff, Mitchell W
• Smits, Pieter C
• Vlachojannis, Georgios J
• Van Mieghem, Nicolas M
• Diletti, Roberto

Titel

Prehospital crushed versus integral prasugrel loading dose in STEMI patients with a large myocardial area

Ist Teil von

• EuroIntervention, 2024-04, Vol.20 (7), p.e436-e444

Ort / Verlag

France

Erscheinungsjahr

2024

Quelle

MEDLINE

Beschreibungen/Notizen

• The effect of administering a crushed prasugrel loading dose is uncertain in patients presenting with a large myocardial infarction and ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate if patients with a large myocardial infarction may benefit from prehospital administration of a crushed prasugrel loading dose. Patients from the CompareCrush trial with an available ambulance electrocardiography (ECG) were included in the study. An independent core laboratory confirmed a prehospital large myocardial area. We compared pre- and postprocedural angiographic markers, including Thrombolysis in Myocardial Infarction (TIMI) 3 flow in the infarct-related artery, high thrombus burden, and myocardial blush grade 3, in STEMI patients with and without a prehospital large myocardial area. Ambulance ECG was available for 532 patients, of whom 331 patients were identified with a prehospital large myocardial area at risk. Crushed prasugrel significantly improved postprocedural TIMI 3 flow rates in STEMI patients with a prehospital large myocardial area at risk (92% vs 79%, odds ratio [OR] 3.00, 95% confidence interval [CI]: 1.50-6.00) but not in STEMI patients without a prehospital large myocardial area at risk (91% vs 95%, OR 0.47, 95% CI: 0.14-1.57; p =0.009). Administration of crushed prasugrel may improve postprocedural TIMI 3 flow in STEMI patients with signs of a large myocardial area at risk on the ambulance ECG. The practice of crushing tablets of prasugrel loading dose might, therefore, represent a safe, fast and cost-effective strategy to improve myocardial reperfusion in this high-risk STEMI subgroup undergoing primary percutaneous coronary intervention.