Comparison of Prasugrel and Ticagrelor in the Treatment of Acute Myocardial Infarction

Comparison of Prasugrel and Ticagrelor in the Treatment of Acute Myocardial Infarction

This study evaluates the efficacy of Prasugrel and Ticagrelor in the treatment of acute myocardial infarction.

Study objectives:

1. Compare the efficacy and safety of prasugrel and ticagrelor in acute myocardial infarction treated with emergent PCI.
2. Assess the safety of switching to clopidogrel after remission of the acute phase of MI in patients for whom economic barriers do not allow to continue treatment with prasugrel or ticagrelor. All randomized patients with acute myocardial infarction have been treated with standard therapeutic procedures in accordance with the guidelines of European Society of Cardiology (ESC). Participation of patients in the study is not connected to any deviations from the ESC guidelines recommendations.

Inclusion Criteria:

1. Acute myocardial infarction (> 1mm ST elevation in at least 2 related leads or ST depression > 2mm in 3 leads or new BBB) with an indication to emergent (within 120 minut from admission to the PCI center) coronary angiography and PCI,
2. Signed informed consent.

Exclusion Criteria:

1. History of stroke,
2. Serious bleeding within last 6 months,
3. Indication to an oral anticoagulation (e.g. atrial fibrillation, artificial valve, thromboembolism etc...)
4. Use of ≥ 300 mg of clopidogrel or another antiplatelet agent (except of aspirin and lower dose of clopidogrel) before randomization,
5. Low body weight (<60 kg) in an older patient (>75 years of age),
6. Moderate or severe liver dysfunction,
7. Ongoing therapy with a strong CYP3A4 inhibitor (e.g. ketoconazole, clarythromycine, nefazodone, ritonavir, atazanavit),
8. Hypersensitivity to prasugrel or ticagrelor.