rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2018-14-6-935-943rpcardio-1811Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯP2Y12 Receptor Inhibitors in the Treatment of Patients with Acute Coronary Syndrome and Percutaneous Coronary Intervention: Possibilities of PrasugrelИнгибиторы Р2Y12-рецепторов в лечении пациентов с острым коронарным синдромом и чрескожным коронарным вмешательством: возможности прасугрелаВоробьеваН. М.VorobyevaN. M.

д.м.н., зав. лабораторией сердечно-сосудистого старения, Российский геронтологический научно-клинический центр

MD, PhD, Head of, Laboratory of Cardiovascular Aging, Russian Gerontology Clinical Research Center

natalyavorobjeva@mail.ruРоссийский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation201805012019146935943Copyright © Vorobyeva N.M., 20192019Воробьева Н.М.Vorobyeva N.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/1811

The possibilities of P2Y12 receptor inhibitors application in the treatment of patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) are discussed in the article. The results of 4 registries in which a comparative analysis of the efficacy and safety of prasugrel with clopidogrel or ticagrelor was performed, as well as of all 3 P2Y12-receptor inhibitors among themselves, are considered in detail. The feasibility of replacing clopidogrel to prasugrel during the inpatient treatment of patients with ACS and PCI was evaluated additionally in the MULTIPRAC registry. The results of the registries demonstrate that the use of prasugrel in patients with ACS and PCI is associated with a significant reduction in the risk of ischemic complications and mortality with an acceptable risk of bleeding. At the same time, prasugrel was more effective and safer than clopidogrel and at least was non-inferior to ticagrelor, and according to some registries, even surpasses it in a number of indicators.

 

В обзорной статье обсуждаются возможности применения ингибиторов P2Y12-рецепторов в лечении пациентов с острым коронарным синдромом (ОКС), подвергаемых чрескожным коронарным вмешательствам (ЧКВ). Подробно рассмотрены результаты 4-х регистров, в которых выполнен сравнительный анализ эффективности и безопасности прасугрела с клопидогрелом или тикагрелором, а также всех 3-х ингибиторов P2Y12-рецепторов между собой. В регистре MULTIPRAC дополнительно оценили целесообразность перехода с терапии клопидогрелом на прием прасугрела в период стационарного лечения пациентов с ОКС и ЧКВ. Результаты регистров указывают на то, что применение прасугрела у пациентов с ОКС и ЧКВ ассоциируется со значительным снижением риска ишемических осложнений и смертности при приемлемом риске кровотечений, при этом прасугрел эффективнее и безопаснее клопидогрела и, как минимум, не уступает тикагрелору, а по данным некоторых регистров, даже превосходит его по ряду показателей.

острый коронарный синдроминфаркт миокардачрескожное коронарное вмешательствоингибиторы P2Y12-рецепторовклопидогрелпрасугрелтикагрелорacute coronary syndromemyocardial infarctionpercutaneous coronary interventionP2Y12 receptor inhibitorsclopidogrelprasugrelticagrelorReferencesO’Gara P.T., Kushner F.G., Ascheim D.D. et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):529-55. doi:10.1161/CIR.0b013e3182742c84.O’Gara P.T., Kushner F.G., Ascheim D.D. et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):529-55. doi:10.1161/CIR.0b013e3182742c84.Amsterdam E.A., Wenger N.K., Brindis R.G. et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130 (25):e344-e426. doi:10.1161/CIR.0000000000000134.Amsterdam E.A., Wenger N.K., Brindis R.G. et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130 (25):e344-e426. doi:10.1161/CIR.0000000000000134.Roffi M., Patrono C., Collet J.-P. et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315. doi:10.1093/eurheartj/ehv320.Roffi M., Patrono C., Collet J.-P. et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315. doi:10.1093/eurheartj/ehv320.Ibanez B., James S., Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi:10.1093/eurheartj/ehx393.Ibanez B., James S., Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi:10.1093/eurheartj/ehx393.Valgimigli M., Bueno H., Byrne R.A. et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J. 2018;39(3):213-60. doi:10.1093/eurheartj/ehx419.Valgimigli M., Bueno H., Byrne R.A. et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J. 2018;39(3):213-60. doi:10.1093/eurheartj/ehx419.Wiviott S.D., Braunwald E., McCabe C.H. et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001-15. doi:10.1056/NEJMoa0706482.Wiviott S.D., Braunwald E., McCabe C.H. et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001-15. doi:10.1056/NEJMoa0706482.Wallentin L., Becker R.C., Budaj A.C. et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045-57. doi:10.1056/NEJMoa0904327.Wallentin L., Becker R.C., Budaj A.C. et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045-57. doi:10.1056/NEJMoa0904327.Antman E.M., Wiviott S.D., Murphy S.A. et al. Early and late benefits of prasugrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a TRITON-TIMI 38 (Trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction) analysis. J Am Coll Cardiol. 2008;51(21):2028-33. doi:10.1016/j.jacc.2008.04.002.Antman E.M., Wiviott S.D., Murphy S.A. et al. Early and late benefits of prasugrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a TRITON-TIMI 38 (Trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction) analysis. J Am Coll Cardiol. 2008;51(21):2028-33. doi:10.1016/j.jacc.2008.04.002.James S., Akerblom A., Cannon C.P. et al. Comparison of ticagrelor, the first reversible oral P2Y(12) receptor antagonist, with clopidogrel in patients with acute coronary syndromes: Rationale, design, and baseline characteristics of the PLATelet inhibition and patient Outcomes (PLATO) trial. Am Heart J. 2009;157(4):599-605. doi:10.1016/j.ahj.2009.01.003.James S., Akerblom A., Cannon C.P. et al. Comparison of ticagrelor, the first reversible oral P2Y(12) receptor antagonist, with clopidogrel in patients with acute coronary syndromes: Rationale, design, and baseline characteristics of the PLATelet inhibition and patient Outcomes (PLATO) trial. Am Heart J. 2009;157(4):599-605. doi:10.1016/j.ahj.2009.01.003.Wallentin L. P2Y(12) inhibitors: differences in properties and mechanisms of action and potential consequences for clinical use. Eur Heart J. 2009;30(16):1964-77. doi:10.1093/eurheartj/ehp296.Wallentin L. P2Y(12) inhibitors: differences in properties and mechanisms of action and potential consequences for clinical use. Eur Heart J. 2009;30(16):1964-77. doi:10.1093/eurheartj/ehp296.Larmore C., Effron M.B., Molife C. et al. «Real-World» Comparison of Prasugrel With Ticagrelor in Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention in the United States. Catheterization and Cardiovascular Interventions. 2016;88:535-44. doi:10.1002/ccd.26279.Larmore C., Effron M.B., Molife C. et al. «Real-World» Comparison of Prasugrel With Ticagrelor in Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention in the United States. Catheterization and Cardiovascular Interventions. 2016;88:535-44. doi:10.1002/ccd.26279.Effient® [package insert]. Parsippany, NJ: Daiichi Sankyo, Inc./Indianapolis, IN: Eli Lilly and Company; November, 2013. [cited by Oct 21, 2018] Available at: http://pi.lilly.com/us/effient.pdf.Effient® [package insert]. Parsippany, NJ: Daiichi Sankyo, Inc./Indianapolis, IN: Eli Lilly and Company; November, 2013. [cited by Oct 21, 2018] Available at: http://pi.lilly.com/us/effient.pdf.Wiviott S.D., Desai N., Murphy S.A. et al. Efficacy and safety of intensive antiplatelet therapy with prasugrel from TRITON-TIMI 38 in a core clinical cohort defined by worldwide regulatory agencies. Am J Cardiol. 2011;108:905-11. doi:10.1016/j.amjcard.2011.05.020.Wiviott S.D., Desai N., Murphy S.A. et al. Efficacy and safety of intensive antiplatelet therapy with prasugrel from TRITON-TIMI 38 in a core clinical cohort defined by worldwide regulatory agencies. Am J Cardiol. 2011;108:905-11. doi:10.1016/j.amjcard.2011.05.020.Goldstein P., Grieco N., Ince H. et al. On behalf of the MULTIPRAC study investigators. Mortality in primary angioplasty patients starting antiplatelet therapy with prehospital prasugrel or clopidogrel: a 1-year follow-up from the European MULTIPRAC Registry. Vascular Health and Risk Management. 2016;12:143-51. doi:10.2147/VHRM.S95391.Goldstein P., Grieco N., Ince H. et al. On behalf of the MULTIPRAC study investigators. Mortality in primary angioplasty patients starting antiplatelet therapy with prehospital prasugrel or clopidogrel: a 1-year follow-up from the European MULTIPRAC Registry. Vascular Health and Risk Management. 2016;12:143-51. doi:10.2147/VHRM.S95391.Khayata M., Gabra J.N., Nasser M.F. et al. Comparison of Clopidogrel With Prasugrel and Ticagrelor in Patients With Acute Coronary Syndrome: Clinical Outcomes From the National Cardiovascular Database ACTION Registry. Cardiol Res. 2017;8(3):105-10. doi:10.14740/cr560w.Khayata M., Gabra J.N., Nasser M.F. et al. Comparison of Clopidogrel With Prasugrel and Ticagrelor in Patients With Acute Coronary Syndrome: Clinical Outcomes From the National Cardiovascular Database ACTION Registry. Cardiol Res. 2017;8(3):105-10. doi:10.14740/cr560w.Olier I., Sirker A., Hildick-Smith D.J.R. et al., on behalf of the British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Association of different antiplatelet therapies with mortality after primary percutaneous coronary intervention. Heart. 2018;104(20):1683-90. doi:10.1136/heartjnl-2017-312366.Olier I., Sirker A., Hildick-Smith D.J.R. et al., on behalf of the British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Association of different antiplatelet therapies with mortality after primary percutaneous coronary intervention. Heart. 2018;104(20):1683-90. doi:10.1136/heartjnl-2017-312366.

The authors declare that there are no conflicts of interest present.