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

Study Overview
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Brief Summary
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This study evaluates the efficacy of Prasugrel and Ticagrelor in the treatment of acute myocardial infarction.

Detailed Description
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Study objectives: Compare the efficacy and safety of prasugrel and ticagrelor in acute myocardial infarction treated with emergent PCI. 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.

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

Conditions
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Myocardial Infarction, Angioplasty, Balloon, Coronary, Platelet Aggregation Inhibitors

Intervention / Treatment
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* Drug: Prasugrel
* Drug: Ticagrelor


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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patients treated with Prasugrel<br>Prasugrel Loading dose: 60 mg Maintenance dose: 10 mg once-daily; patients >75 years of age or < 60 kg of weight receive a maintenance dose of 5 mg o.d. | Drug: Prasugrel<br>* Prasugrel 60 mg loading dose and 10mg/5mg once daily maintenance dose<br>* Other names: Efient;|
| Experimental: Patients treated with ticagrelor<br>Ticagrelor Loading dose: 180 mg Maintenance dose: 90mg twice-daily | Drug: Ticagrelor<br>* Ticagrelor 180 mg loading dose and 90 mg twice daily maintenance dose<br>* Other names: Brilique;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Composite primary outcome measure consisting of Death / Re-infarction / Stroke / Serious bleeding requiring transfusion or prolonged hospitalization / Urgent Target Vessel Revascularization. | Definitions: Death defined as summary of death from any cause. Re-infarcion defined according to the Third Universal Definition of Myocardial Infarction. Stroke defined as the rapid onset of new neurological deficit caused by an ischemic or hemorrhagic central nervous system event with symptoms that lasted at least 24 hours after onset or leading to death. Urgent Target Vessel Revascularization defined as a new emergent/urgent revascularization of the vessel dilated at the initial procedure driven by recurrent signs of ischemia occurring after completion of initial PCI. Units: The percentage of randomized patients is the total number of randomized patients experiencing Death / Re-infarction / Stroke / Serious bleeding requiring transfusion or prolonged hospitalization / Urgent Target Vessel Revascularization divided by number of randomized patients in the treatment arm multiplied by 100. Primary endpoint is adjudicated by the Independent Control committee | Within 7 days after Randomization. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Composite secondary outcome measure consisting of Cadiovascular death / Non-fatal myocardial infarction / Stroke. | Definition: Cardiovascular death defined as a death with a demonstrable cardiovascular cause, or any death that is not clearly attributable to a non-cardiovascular cause. Non-fatal myocardial infarction must be distinct from the index event and is defined according to the Third Universal Definition of Myocardial Infarction. Units: The percentage of randomized patients is the total number of randomized patients experiencing Cadiovascular death / Non-fatal myocardial infarction / Stroke divided by number of randomized patients in the treatment arm multiplied by 100. | Within 30 days and one year after Randomization. | 
| Stent thrombosis. | Definition: Academic Research Consortium (ARC) criteria were used to define ST. Units: The percentage of randomized patients is the total number of randomized patients experiencing Stent thrombosis divided by number of randomized patients in the treatment arm multiplied by 100. | Within 30 days and one year after Randomization. | 
| Occurence of bleeding according to the TIMI and BARC criteria. | TIMI criteria - Thrombolysis In Myocardial Infarction Criteria BARC criteria - Bleeding Academic Research Consortium criteria Units: The percentage of randomized patients is the total number of randomized patients experiencing bleeding according to the TIMI and BARC criteria divided by number of randomized patients in the treatment arm multiplied by 100. | Within 30 days and one year after Randomization. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute myocardial infarction, Primary coronary intervention, Antiplatelet therapy