New European Society of Cardiology (ESC) guidelines have given prasugrel a Class I recommendation for treatment of certain patients undergoing percutaneous coronary intervention (PCI).
Those patients awaiting PCI who have experienced a non-ST-segment elevation acute coronary syndrome (NSTE-ACS), which comprises non-ST segment elevation myocardial infarction or NSTEMI – a type of heart attack – and unstable angina (UA), should be given the antiplatelet presugrel once a day (level of evidence B).
The ESC Guidelines Committee endorsed the use of prasugrel in UA/NSTEMI patients (especially those with diabetes) who are clopidogrel naïve in whom coronary anatomy is known and who are proceeding to PCI. The guidelines were presented at the ESC Congress 2011 in Paris and are published in the European Heart Journal
“UA and NSTEMI patients are at high risk of cardiovascular events, and they often represent a challenge in clinical practice. There is a significant body of evidence which showed that prasugrel can form part of an appropriate management strategy to minimise risk for these patients,” said Professor Gilles Montalescot, Head of the Cardiac Care Unit at Pitié-Salpétrière Hospital, Paris, France.
“The guidelines, based on the latest clinical evidence, set out clear recommendations that offer alternative treatment options, such as prasugrel, for treating some of these high-risk patients.”
In the updated guidelines – entitled Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation – prasugrel was recommended regardless of a patient’s genetic status, and the guidelines state prasugrel does not appear to be affected by cytochrome P450 (CYP) inhibitors, including proton pump inhibitors.
NSTEMI and UA account for about 2.5 million hospital admissions worldwide. In Western countries, NSTE-ACS (NSTEMI and UA) is the most frequent type of ACS and represents the largest group of patients undergoing PCI.