# Timing van prasugrel-start en coronairangiografie bij NSTEMI

*geplaatst 2019-03-05 · Algemeen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2018.11.055 · https://hartvaat.nl/2019/03/05/timing-van-prasugrel-start-en-coronairangiografie-bij-nstemi/*

Studie naar het optimale interval tussen prasugrel-initiatie en coronairangiografie bij NSTEMI.

## English: Interval From Initiation of Prasugrel to Coronary Angiography in Patients With Non-ST-Segment Elevation Myocardial Infarction.

This ACCOAST analysis examined the optimal time interval between prasugrel initiation and coronary angiography in NSTEMI, informing the pre-treatment timing strategy for potent P2Y12 inhibition.

## Abstract (original, from the publication)

BACKGROUND: In the ACCOAST (A Comparison of Prasugrel at PCI or Time of Diagnosis of Non-ST Elevation Myocardial Infarction) trial, the prasugrel pre-treatment strategy versus placebo was associated with excess bleeding complications and no improved ischemic outcome in non-ST-segment elevation myocardial infarction (MI). Whether patients with the longest pre-treatment duration had an ischemic benefit is unknown. OBJECTIVES: This pre-specified analysis of the ACCOAST trial aimed to assess the effect of pre-treatment duration with prasugrel (time from randomization to angiography) on outcomes. METHODS: Within the 4,033 patients randomized in the ACCOAST trial, pre-treatment duration was available in 4,001 patients (99.2%). The population of the trial was divided into quartiles of pre-treatment duration (0.1 to 2.5 h, 2.5 to 3.9 h, 3.9 to 13.6 h, and >13.6 h) with an evaluation of the primary efficacy endpoint of cardiovascular death, MI, stroke, urgent revascularization or glycoprotein IIb/IIIa inhibitor bailout use. Secondary efficacy outcomes including cardiovascular death, MI, or stroke; all-cause death; stent thrombosis and safety outcomes (all coronary artery bypass graft [CABG] or non-CABG TIMI [Thrombolysis In Myocardial Infarction] major bleeding) were also evaluated at 7 days. RESULTS: The primary efficacy outcome of cardiovascular death, MI, stroke, urgent revascularization or glycoprotein IIb/IIIa inhibitor bailout use did not differ between the quartiles of pre-treatment duration in the trial population (p = 0.17 for interaction). None of the secondary efficacy outcomes were found to be dependent on pre-treatment duration. The safety outcome of all CABG or non-CABG TIMI major bleeding did not differ between the quartiles of pre-treatment duration (p = 0.37 for interaction). CONCLUSIONS: In non-ST-segment elevation MI patients, the excess risk of bleeding and the absence of ischemic benefit were consistent across the quartiles of increasing duration of prasugrel pre-treatment. (A Comparison of Prasugrel at PCI or Time of Diagnosis of Non-ST Elevation Myocardial Infarction [ACCOAST]; NCT01015287).

Auteurs: Johanne Silvain, Tomasz Rakowski, Benoit Lattuca, Zhenyu Liu, Leonardo Bolognese, Patrick Goldstein, Christian Hamm, Jean-Francois Tanguay, Jur Ten Berg, Petr Widimsky, Debra Miller, Jean-Jacques Portal, Jean-Philippe Collet, Eric Vicaut, Gilles Montalescot, Dariusz Dudek

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2018.11.055. Bijgewerkt 2026-07-03T13:27:01Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.