The University of Southampton
University of Southampton Institutional Repository

Infarct size following treatment with second- versus third-generation P2Y12 antagonists in patients with multivessel coronary disease at ST-segment elevation myocardial infarction in the CvLPRIT Study

Infarct size following treatment with second- versus third-generation P2Y12 antagonists in patients with multivessel coronary disease at ST-segment elevation myocardial infarction in the CvLPRIT Study
Infarct size following treatment with second- versus third-generation P2Y12 antagonists in patients with multivessel coronary disease at ST-segment elevation myocardial infarction in the CvLPRIT Study

BACKGROUND: Third-generation P2Y12 antagonists (prasugrel and ticagrelor) are recommended in guidelines on ST-segment elevation myocardial infarction. Mechanisms translating their more potent antiplatelet activity into improved clinical outcomes versus the second-generation P2Y12 antagonist clopidogrel are unclear. The aim of this post hoc analysis of the Complete Versus Lesion-Only PRImary PCI Trial-CMR (CvLPRIT-CMR) substudy was to assess whether prasugrel and ticagrelor were associated with reduced infarct size compared with clopidogrel in patients undergoing primary percutaneous coronary intervention.

METHODS AND RESULTS: CvLPRIT-CMR was a multicenter, prospective, randomized, open-label, blinded end point trial in 203 ST-segment elevation myocardial infarction patients with multivessel disease undergoing primary percutaneous coronary intervention with either infarct-related artery-only or complete revascularization. P2Y12 inhibitors were administered according to local guidelines. The primary end point of infarct size on cardiovascular magnetic resonance was not significantly different between the randomized groups. P2Y12 antagonist administration was not randomized. Patients receiving clopidogrel (n=70) compared with those treated with either prasugrel or ticagrelor (n=133) were older (67.8±12 versus 61.5±10 years, P<0.001), more frequently had hypertension (49% versus 29%, P=0.007), and tended to have longer symptom-to-revascularization time (234 versus 177 minutes, P=0.05). Infarct size (median 16.1% [quartiles 1-3, 10.5-27.7%] versus 12.1% [quartiles 1-3, 4.8-20.7%] of left ventricular mass, P=0.013) and microvascular obstruction incidence (65.7% versus 48.9%, P=0.022) were significantly greater in patients receiving clopidogrel. Infarct size remained significantly different after adjustment for important covariates using both generalized linear models (P=0.048) and propensity score matching (P=0.025).

CONCLUSIONS: In this analysis of CvLPRIT-CMR, third-generation P2Y12 antagonists were associated with smaller infarct size and lower microvascular obstruction incidence versus the second-generation P2Y12 antagonist clopidogrel for ST-segment elevation myocardial infarction.

CLINICAL TRIAL REGISTRATION: URL: http://www.isrctn.com/ISRCTN70913605.

Adenosine/administration & dosage, Aged, Clopidogrel, Coronary Angiography, Coronary Stenosis/drug therapy, Drug Administration Schedule, Female, Humans, Magnetic Resonance Angiography, Male, Microvessels, Middle Aged, Myocardial Revascularization, Organ Size, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors/administration & dosage, Prasugrel Hydrochloride/administration & dosage, Prospective Studies, Purinergic P2Y Receptor Antagonists/administration & dosage, ST Elevation Myocardial Infarction/drug therapy, Ticagrelor, Ticlopidine/administration & dosage, Time Factors, Treatment Outcome
Khan, Jamal N.
6a97c4cf-a472-4fef-94e6-2bbd66eb44bf
Greenwood, John P.
af864161-94e9-4094-9c1f-85d696682fb7
Nazir, Sheraz A.
e1f416ed-9bba-41ab-aa45-564cfe1416b8
Lai, Florence Y.
7047aa07-9466-43ff-9919-b7ee243f340c
Dalby, Miles
0296ef2f-0e85-41da-974c-2e709b9494c6
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Hetherington, Simon
491bfdf8-38b8-4573-9ea8-aeb59f162f31
Kelly, Damian J.
2dc363f6-884a-4f82-a4d7-bfadf72f9533
Blackman, Daniel
1c03cb3f-3b7e-4f4c-94ed-9b438c4e6243
Peebles, Charles
2f68f796-caf1-4b5b-993f-611e90648988
Wong, Joyce
7ecd4a8b-4083-498c-9684-eb3dc88fdb96
Flather, Marcus
f1c158fe-9da3-4604-adfc-a5f8db10d5d3
Swanton, Howard
3704efef-33b4-430d-a819-60d1bba99706
Gershlick, Anthony H.
5beb7f92-68f7-41df-ba72-ef3d2cdf20b9
McCann, Gerry P.
8e61a5f4-0764-4adf-bc9c-5abba82425fc
Khan, Jamal N.
6a97c4cf-a472-4fef-94e6-2bbd66eb44bf
Greenwood, John P.
af864161-94e9-4094-9c1f-85d696682fb7
Nazir, Sheraz A.
e1f416ed-9bba-41ab-aa45-564cfe1416b8
Lai, Florence Y.
7047aa07-9466-43ff-9919-b7ee243f340c
Dalby, Miles
0296ef2f-0e85-41da-974c-2e709b9494c6
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Hetherington, Simon
491bfdf8-38b8-4573-9ea8-aeb59f162f31
Kelly, Damian J.
2dc363f6-884a-4f82-a4d7-bfadf72f9533
Blackman, Daniel
1c03cb3f-3b7e-4f4c-94ed-9b438c4e6243
Peebles, Charles
2f68f796-caf1-4b5b-993f-611e90648988
Wong, Joyce
7ecd4a8b-4083-498c-9684-eb3dc88fdb96
Flather, Marcus
f1c158fe-9da3-4604-adfc-a5f8db10d5d3
Swanton, Howard
3704efef-33b4-430d-a819-60d1bba99706
Gershlick, Anthony H.
5beb7f92-68f7-41df-ba72-ef3d2cdf20b9
McCann, Gerry P.
8e61a5f4-0764-4adf-bc9c-5abba82425fc

Khan, Jamal N., Greenwood, John P., Nazir, Sheraz A., Lai, Florence Y., Dalby, Miles, Curzen, Nick, Hetherington, Simon, Kelly, Damian J., Blackman, Daniel, Peebles, Charles, Wong, Joyce, Flather, Marcus, Swanton, Howard, Gershlick, Anthony H. and McCann, Gerry P. (2016) Infarct size following treatment with second- versus third-generation P2Y12 antagonists in patients with multivessel coronary disease at ST-segment elevation myocardial infarction in the CvLPRIT Study. Journal of the American Heart Association, 5 (6). (doi:10.1161/JAHA.116.003403).

Record type: Article

Abstract

BACKGROUND: Third-generation P2Y12 antagonists (prasugrel and ticagrelor) are recommended in guidelines on ST-segment elevation myocardial infarction. Mechanisms translating their more potent antiplatelet activity into improved clinical outcomes versus the second-generation P2Y12 antagonist clopidogrel are unclear. The aim of this post hoc analysis of the Complete Versus Lesion-Only PRImary PCI Trial-CMR (CvLPRIT-CMR) substudy was to assess whether prasugrel and ticagrelor were associated with reduced infarct size compared with clopidogrel in patients undergoing primary percutaneous coronary intervention.

METHODS AND RESULTS: CvLPRIT-CMR was a multicenter, prospective, randomized, open-label, blinded end point trial in 203 ST-segment elevation myocardial infarction patients with multivessel disease undergoing primary percutaneous coronary intervention with either infarct-related artery-only or complete revascularization. P2Y12 inhibitors were administered according to local guidelines. The primary end point of infarct size on cardiovascular magnetic resonance was not significantly different between the randomized groups. P2Y12 antagonist administration was not randomized. Patients receiving clopidogrel (n=70) compared with those treated with either prasugrel or ticagrelor (n=133) were older (67.8±12 versus 61.5±10 years, P<0.001), more frequently had hypertension (49% versus 29%, P=0.007), and tended to have longer symptom-to-revascularization time (234 versus 177 minutes, P=0.05). Infarct size (median 16.1% [quartiles 1-3, 10.5-27.7%] versus 12.1% [quartiles 1-3, 4.8-20.7%] of left ventricular mass, P=0.013) and microvascular obstruction incidence (65.7% versus 48.9%, P=0.022) were significantly greater in patients receiving clopidogrel. Infarct size remained significantly different after adjustment for important covariates using both generalized linear models (P=0.048) and propensity score matching (P=0.025).

CONCLUSIONS: In this analysis of CvLPRIT-CMR, third-generation P2Y12 antagonists were associated with smaller infarct size and lower microvascular obstruction incidence versus the second-generation P2Y12 antagonist clopidogrel for ST-segment elevation myocardial infarction.

CLINICAL TRIAL REGISTRATION: URL: http://www.isrctn.com/ISRCTN70913605.

This record has no associated files available for download.

More information

Accepted/In Press date: 9 April 2016
Published date: 31 May 2016
Keywords: Adenosine/administration & dosage, Aged, Clopidogrel, Coronary Angiography, Coronary Stenosis/drug therapy, Drug Administration Schedule, Female, Humans, Magnetic Resonance Angiography, Male, Microvessels, Middle Aged, Myocardial Revascularization, Organ Size, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors/administration & dosage, Prasugrel Hydrochloride/administration & dosage, Prospective Studies, Purinergic P2Y Receptor Antagonists/administration & dosage, ST Elevation Myocardial Infarction/drug therapy, Ticagrelor, Ticlopidine/administration & dosage, Time Factors, Treatment Outcome

Identifiers

Local EPrints ID: 436145
URI: http://eprints.soton.ac.uk/id/eprint/436145
PURE UUID: d7e21670-3bd7-4bfd-a528-d543a63c29d7
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

Catalogue record

Date deposited: 29 Nov 2019 17:30
Last modified: 28 Apr 2022 01:55

Export record

Altmetrics

Contributors

Author: Jamal N. Khan
Author: John P. Greenwood
Author: Sheraz A. Nazir
Author: Florence Y. Lai
Author: Miles Dalby
Author: Nick Curzen ORCID iD
Author: Simon Hetherington
Author: Damian J. Kelly
Author: Daniel Blackman
Author: Charles Peebles
Author: Joyce Wong
Author: Marcus Flather
Author: Howard Swanton
Author: Anthony H. Gershlick
Author: Gerry P. McCann

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×