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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn the largest trial to date of patients with medically managed acute coronary syndrome without revascularization, prasugrel did not improve outcomes, compared with clopidogrel during 2.5 years of follow-up among patients \u0026lt;75 years. The findings are from the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes [TRILOGY ACS] study [Roe MT et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn the largest trial to date of patients with medically managed acute coronary syndrome (ACS) without revascularization, prasugrel did not improve outcomes, compared with clopidogrel during 2.5 years of follow-up among patients \u0026lt;75 years. The findings are from the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes [TRILOGY ACS] study, which was published to coincide with its presentation at the European Society of Cardiology Congress [Roe MT et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe TRILOGY ACS trial is important because 40% to 60% of patients with ACS are managed without revascularization, said Matthew T. Roe, MD, MHS, Duke University Medical Center, Durham, North Carolina, USA. These patients are at high risk for subsequent complications, with rates of ischemic events 2-fold greater than those treated with revascularization. The investigators had hypothesized that prasugrel would be a better option than clopidogrel in patients with medically managed ACS, based on the superiority of prasugrel over clopidogrel in patients with ACS who underwent percutaneous revascularization in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction [TRITON-TIMI 38] trial [Wiviott SD et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ETRILOGY was an international trial that enrolled 9326 patients who were treated medically for unstable angina or non-ST-segment elevated myocardial infarction (NSTEMI). Patients were randomly assigned to treatment with prasugrel (10 mg QD) or clopidogrel (75 mg QD); the dose of prasugrel was reduced to 5 mg QD for patients weighing \u0026lt;60 kg. All patients also received aspirin as part of medical management. The primary analysis involved 7243 of the patients who were \u0026lt;75 years. A secondary, exploratory analysis was performed in 2083 patients who were \u226575 years, who were randomly assigned to prasugrel 5 mg QD or clopidogrel 75 mg QD. The primary endpoint was a composite of cardiovascular death, MI, or stroke. Patients were followed for as long as 30 months.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EDr. Roe reported the findings for the patients \u0026lt;75 years and for the overall population. At a median follow-up of 17 months for the younger patients, the rates of the primary composite endpoint were 13.9% in the group randomized to prasugrel and 16.0% in the clopidogrel group (HR, 0.91; 95% CI, 0.79 to 1.05; p=0.21). The results were similar for the overall patient population (18.7% vs 20.3%; HR, 0.96; 95% CI, 0.86 to 1.07; p=0.45).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAmong patients \u0026lt;75 years, rates of bleeding were assessed according to the Global Use of Strategies to Open Occluded coronary arteries (GUSTO) and Thrombolysis in Myocardial Infarction (TIMI) criteria. Bleeding was low in both treatment groups, with no significant differences except for TIMI major or minor bleeding (1.8% in the prasugrel group vs 1.3% in the clopidogrel group; p=0.02). For the overall population, the rates of TIMI major bleeding were similar with prasugrel compared with clopidogrel (2.5% vs 1.8%; HR, 1.23; 95% CI, 0.84 to 1.81; p=0.29).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EDr. Roe noted that despite the absence of a significant benefit in the primary endpoint, the findings of a prespecified analysis suggested that prasugrel was associated with a lower risk of multiple recurrent ischemic events (not just the first event among all components of the primary endpoint [HR, 0.85; 95% CI, 0.72 to 1.00; p=0.04]) as well as a trend towards a lower risk of ischemic events after 12 months (HR for \u0026gt;12 months, 0.64; 95% CI, 0.48 to 0.86; p=0.02).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThough TRILOGY ACS failed to meet its primary endpoint, it contributes to the knowledge base about ACS patients who are medically managed. Additional analyses and studies will be needed to try to evaluate the role of prasugrel in the management of NSTEMI.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/13\/12.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznb1f\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}