Prasugrel and Ticagrelor in ST-segment Elevation Myocardial Infarction

Comparison of Prasugrel and Ticagrelor Antiplatelet Effects in Korean Patients Presenting With ST-segment Elevation Myocardial Infarction

To compare efficacy and safety of prasugrel and ticagrelor in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Prasugrel and ticagrelor are recommended in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Both prasugrel and ticagrelor show more rapid and potent antiplatelet effect compared with clopidogrel. However, previous report comparing the efficacy and safety of prasugrel and ticagrelor in patients with STEMI of East Asian ethnicity is lacking. Therefore, the aim of this study is to compare the antiplatelet efficacy and safety using laboratory platelet function tests and clinical outcomes in patients with STEMI treated with either prasugrel or ticagrelor.

Inclusion Criteria:

• Patients with ST-segment elevation myocardial infarction
• Undergoing primary percutaneous coronary intervention
• Aged between 20 and 80 years

Exclusion Criteria:

• Previous administration of any antagonist of the platelet adenosine diphosphate (ADP) P2Y12 receptor (clopidogrel, prasugrel or ticagrelor)
• History of stroke or transient ischemic attack
• Previous gastrointestinal bleeding within 6 months, bleeding diathesis, platelet count < 100,000/mm3 or hemoglobin < 10 g/dl
• Chronic oral anticoagulation treatment
• Contraindication to the antiplatelet treatment
• Severe renal insufficiency (serum creatine>2.5 mg/dl)
• Severe hepatic dysfunction (serum liver enzyme or bilirubin>3 times normal limit)
• Sever chronic obstructive pulmonary disease (COPD) or bradycardia
• Body weight < 50 kg