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Impact of smoking status on platelet function and clinical outcomes with prasugrel vs. clopidogrel in patients with acute coronary syndromes managed without revascularization: Insights from the TRILOGY ACS trial

for, t. T. et al.

American heart journal. VOL 168; NUMBER 1, ; 2014, 76-87.e1 -- Elsevier Science B.V., Amsterdam Part 1; (pages 76-87.e1) -- 2014

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  • Title:
    Impact of smoking status on platelet function and clinical outcomes with prasugrel vs. clopidogrel in patients with acute coronary syndromes managed without revascularization: Insights from the TRILOGY ACS trial
  • Author: for, t. T.;
    Cornel, J. H.;
    Ohman, E. M.;
    Neely, B.;
    Clemmensen, P.;
    Sritara, P.;
    Zamoryakhin, D.;
    Armstrong, P. W.;
    Prabhakaran, D.;
    White, H. D.
  • Found In: American heart journal. VOL 168; NUMBER 1, ; 2014, 76-87.e1
  • Journal Title: American heart journal.
  • Subjects: Medicine; Biotechnology; Pharmaceutical Chemistry; LCC: RC681; Dewey: 616.12
  • Publication Details: Elsevier Science B.V., Amsterdam
  • Language: English
  • Abstract: Background: To further explore the impact of smoking on antiplatelet activity and treatment response, we evaluated time-dependent relationships between smoking status with on-treatment platelet reactivity and clinical outcomes for prasugrel vs. clopidogrel in patients with acute coronary syndromes managed medically without revascularization. Methods and Results: A total of 7062 patients aged <75 years from the primary TRILOGY ACS cohort randomized to prasugrel vs. clopidogrel were evaluated through 30 months by baseline and time-dependent smoking status with adjusted proportional-hazards models. A total of 1613 participants (23%) were included in a platelet function sub-study evaluating serial P2Y12 reaction unit (PRU) measurements. Current smokers (n = 1566 [22%]) at baseline had fewer comorbidities compared with non-smokers; nearly half quit smoking during follow-up. Although median on-treatment PRU values were lower with prasugrel vs. clopidogrel, persistent smokers had lower serial PRU values in both treatment groups compared with non-smokers, with no differential interaction of treatment response by smoking status. The frequency of cardiovascular death, myocardial infarction, or stroke in current smokers was significantly lower with prasugrel (11.7%) vs. clopidogrel (18.6%), but there was no difference in non-smokers (13.8% vs. 13.7%), with significant interaction between treatment and baseline smoking status (P = .0002). Bleeding events occurred more frequently in prasugrel-treated patients with no significant interaction between treatment and baseline smoking status. Conclusions: Among medically managed ACS patients <75 years of age, the risk of ischemic outcomes was significantly reduced with prasugrel vs. clopidogrel among smokers vs. non-smokers. No interaction between on-treatment platelet reactivity and smoking status was found.
  • Identifier: Journal ISSN: 0002-8703
  • Publication Date: 2014
  • Physical Description: Physical
  • Accrual Information: Monthly
  • Shelfmark(s): 0817.000000
  • UIN: ETOCRN355093219

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