- Question
- Does giving prasugrel at the time of diagnosis (before coronary angiography) improve outcomes compared with giving it only after angiography when PCI is indicated, in patients with non-ST-segment elevation acute coronary syndrome?
- Design
- Randomized, double-blind, placebo-controlled phase 3 trial enrolling 4033 patients scheduled for coronary angiography 2 to 48 hours after randomization.
- Population
- Patients with non-ST-segment elevation acute coronary syndrome and a positive troponin level, scheduled to undergo coronary angiography.
- Intervention
- Pretreatment with a 30-mg prasugrel loading dose before angiography; if PCI was indicated, a further 30 mg was given at the time of the procedure.
- Control
- Placebo before angiography and, if PCI was indicated, a 60-mg prasugrel loading dose at that time.
- Primary outcome
- Composite of cardiovascular death, myocardial infarction, stroke, urgent revascularization, or glycoprotein IIb/IIIa inhibitor bailout through day 7.
- Results
- The primary endpoint did not differ between groups (HR with pretreatment 1.02; 95% CI 0.84 to 1.25; P=0.81). TIMI major bleeding was increased with pretreatment (HR 1.90; 95% CI 1.19 to 3.02; P=0.006).
- Safety
- Rates of TIMI major bleeding and life-threatening bleeding not related to CABG were increased with pretreatment by a factor of 3 and 6, respectively.
- Conclusion
- In patients with NSTE acute coronary syndrome scheduled for catheterization, prasugrel pretreatment did not reduce major ischemic events up to 30 days and increased major bleeding complications.
- Why it matters
- It challenged the routine practice of giving a potent P2Y12 inhibitor before the coronary anatomy is known, by showing greater bleeding risk without an ischemic benefit.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 10, 2026