Prasugrel versus Clopidogrel for Acute Coronary Syndromes without Revascularization

At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrelgroup and 16.0% of the clopidogrelgroup ( hazard ratioin the prasugrelgroup, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P = 0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrelamong patients under the age of 75 years ( hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P = 0.04). Rates of severe and intracranial bleedingwere similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrelgroup. Conclusions Among patients with unstable anginaor myocardial infarction without ST-segment elevation, prasugreldid not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGYACS ClinicalTrials.gov number, NCT00699998.)