ACCOAST

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Montalescot G, et al. "Pretreatment with Prasugrel in Non–ST-Segment Elevation Acute Coronary Syndromes". The New England Journal of Medicine. 2013. 369(11):999-1010.
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Clinical Question

In patients with UA/NSTEMI, does administering prasugrel before or after planned PCI have an effect on CV complications?

Bottom Line

In patients with UA/NSTEMI, Early administration of prasugrel does not reduce CV complications when compared to delayed administration.

Major Points

Among patients with NSTE acute coronary syndromes who were scheduled to undergo catheterization, pretreatment with prasugrel did not reduce the rate of major ischemic events up to 30 days but increased the rate of major bleeding complications.

Guidelines

Design

  • Multicenter, randomized, double-blind, event-driven study
  • N=4,033
    • Pretreatment (n=2,037)
    • No pretreatment(n=1,996)
  • Setting: 171 centers in 19 countries
  • Enrollment: 2009-2012
  • Follow-up: 7 days, 30 days
  • Analysis: Intention-to-treat
  • Primary outcome: Composite of first occurrence of death from cardiovascular causes, myocardial infarction, stroke, urgent revascularization, or the need for rescue therapy with glycoprotein IIb/IIIa inhibitors (glycoprotein IIb/IIIa bailout) through day 7 after randomization.

Population

Inclusion Criteria

  • Diagnosis of Non-ST-segment acute coronary syndrome
  • Elevated troponin level

Exclusion Criteria

  • Receipt of a loading dose of a P2Y12 inhibitor before randomization

Baseline Characteristics

Interventions

Outcomes

Primary Outcomes

Secondary Outcomes

Subgroup Analysis

Adverse Events

Criticisms

Funding

Further Reading