COMPARE CRUSH: Integral and Crushed Pills Same for TIMI Flow Post-PCI

Crushing prasugrel tablets does not improve TIMI 3 flow in the time just after primary percutaneous coronary intervention (PCI), a new study presented at Transcatheter Cardiovascular Therapeutics (TCT) 2020 suggests.

“High platelet reactivity during the acute phase of myocardial infarction correlates with the extent of myocardial damage, suboptimal flow in the infarct0related artery after primary PCI, and the extent of microvascular obstruction, the researchers noted. “However, onset of platelet inhibition by oral P2Y12 antagonist in patients presenting with STEMI is delayed for several hours dur to slow gastrointestinal absorption.

The prospective, multicenter, randomized controlled trial included 777 STEMI patients with symptom onset at six hours or less from planned primary PCI randomly given aspirin and heparin in the ambulance, as well as either prasugrel crushed tablets 60 mg, or prasugrel 60 mg integral tablets. The primary study endpoints were TIMI 3 flow in the infarct-related artery at first angiography, and ≥70% ST-segment resolution one hour after primary PCI.

According to the study results, TIMI 3 flow in the infarct-related artery was 31.0% in the crushed prasugrel arm and 32.7% in the integral arm (OR=0.92; 95% CI, 0.65 to 1.30). Complete ST-segment resolution at one hour post-PCI was 59.9% in the crushed pill group vs. 57.3% in the integral group (OR=1.11; 95% CI, 0.78 to 1.58). The researchers also reported that the proportion of patients with high platelet reactivity at the beginning of primary PCI was higher in the integral pill group compared with the crushed pill group (P<0.01).

“Pre-hospital administration of crushed tablets of prasugrel loading dose in STEMI patients planned for primary PCI does not improve TIMI 3 flow in the IRS at first angiography, or ST-segment resolution at one hour post-PCI,” the researchers said in their presentation. “These findings hold in spite of the fact that crushed tablets of prasugrel lead to more potent platelet inhibition compared with integral tablets. Whether faster and more potent antiplatelet therapy can improve coronary reperfusion in contemporary STEMI treatment regimen warrants further investigation.”

Vlachojannis GJ. A Randomized Trial Of Prehospital Crushed Vs Uncrushed Prasugrel In STEMI. Presented at TCT 2020.