Mortality benefit with prasugrel in the triton–timi 38 coronary artery bypass grafting cohort: risk-adjusted retrospective data analysis
JACC Cardiovascular Interventions, 07/31/2012
Smith PK et al. – Despite an increase in observed bleeding, platelet transfusion, and surgical re–exploration for bleeding, prasugrel was associated with a lower rate of death after coronary artery bypass grafting (CABG) compared with clopidogrel.Methods
- A subset of the TRITON–TIMI 38 study (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel–Thrombolysis In Myocardial Infarction 38), in which patients with acute coronary syndrome were randomized to treatment with aspirin and either clopidogrel or prasugrel, underwent isolated CABG (N = 346).
- A supplemental case report form was designed and administered, and the data combined with the existing TRITON–TIMI 38 database.
- Baseline imbalances were corrected for using elements of the European System for Cardiac Operative Risk Evaluation and The Society of Thoracic Surgeons predictive algorithm.
- A significantly higher mean 12–h chest tube blood loss (655 ± 580 ml vs. 503 ± 378 ml; p = 0.050) was observed with prasugrel compared with clopidogrel, without significant differences in red blood cell transfusion (2.1 U vs. 1.7 U; p = 0.442) or the total donor exposure (4.4 U vs. 3.0 U; p = 0.463).
- All–cause mortality was significantly reduced with prasugrel (2.31%) compared with 8.67% with clopidogrel (adjusted odds ratio: 0.26; p = 0.025).