Platelet reactivity outcomes Myocardial infarction Myocardial - - PowerPoint PPT Presentation

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Jul 01, 2023 318 likes •443 views

The ANTARCTIC investigators The ANTARCTIC investigators A ssessment of a N ormal versus T ailored dose of prasugrel after stenting in patients A ged > 75 years to R educe the C omposite of bleeding, stent T hrombosis and I schemic C omplications

SLIDE 1

The ANTARCTIC investigators

ANTARCTIC a study by the ACTION Group

Assessment of a Normal versus Tailored dose of prasugrel after stenting in patients Aged > 75 years to Reduce the Composite of bleeding, stent Thrombosis and Ischemic Complications The ANTARCTIC investigators

SLIDE 2

Dr. G. Montalescot reports research Grants to the Institution or Consulting/Lecture Fees

from ADIR, Amgen, AstraZeneca, Bayer, Berlin Chimie AG, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, Cardiovascular Research Foundation, Celladon, CME Resources, Daiichi-Sankyo, Eli- Lilly, Europa, Elsevier, Fédération Française de Cardiologie, Fondazione Anna Maria

ANTARCTIC a study by the ACTION Group

Lilly, Europa, Elsevier, Fédération Française de Cardiologie, Fondazione Anna Maria Sechi per il Cuore, Gilead, ICAN, Janssen, Lead-Up, Menarini, Medtronic, MSD, Pfizer, Sanofi-Aventis, The Medicines Company, TIMI Study Group, WebMD.

SLIDE 3

Platelet reactivity

utcomes

PRU PRU >208 (n=3610) >208 (n=3610) PRU PRU ≤208 (n=4839 ≤208 (n=4839) )

10 10

6.7% 6.7% 5.6% 5.6%

Major bleeding Major bleeding

HR [95%CI] = HR [95%CI] = 0.83 [0.69, 0.99] P=0.04 P=0.04

Myocardial infarction Myocardial infarction

HR [95%CI] = HR [95%CI] = 1.47 [1.15, 1.87] P=0.002 P=0.002 PRU PRU >208 (n=3610) >208 (n=3610) PRU PRU ≤208 (n=4839) ≤208 (n=4839)

10 10

ANTARCTIC a study by the ACTION Group

5 5

Months Months

6 6 12 12 5 5

Months Months

6 6 12 12

3.9% 3.9% 2.7% 2.7%

Stone GW et al. Lancet 2013; 382(9892): 614-23

SLIDE 4

ARCTIC

Standard of care VerifyNow P2Y12 + ASA

Drug and Dose adjustments if high

Coronary angiogram Rd

ANTARCTIC a study by the ACTION Group

adjustments if high platelet reactivity

Stent-PCI Standard of care

Drug and Dose adjustments if high platelet reactivity at Day 14

12-month FU Stent-PCI

Collet JP et al. N Engl J Med. 2012 Nov 29;367:2100-9.

SLIDE 5

Criticism after ARCTIC

Elderly, ACS patients Urgent PCI

Low risk, stable patients
Elective PCI
ANTARCTIC

ANTARCTIC a study by the ACTION Group

Predominant use of prasugrel

New PRU thresholds
Predominant use of clopidogrel
Old PRU thresholds

Montalescot G et al. N Engl J Med 2013;368:871-2 Montalescot G et al. Circulation 2014;129:2136-43

SLIDE 6

Conventional Arm :Prasugrel 5 mg Group 1 No monitoring Monitoring Arm :Prasugrel 5 mg

1st assessment : Verifynow P2Y12 : 2 weeks ± 2 d

Group 2

ANTARCTIC design ANTARCTIC a study by the ACTION Group

PRU≥208

Prasugrel 10 mg/day Clopidogrel 75 mg/day

Prasugrel 5 mg

Primary end point (net clinical benefit) over 12 months:: Bleeding type 2,3,5 of the BARC definition andMACE (CV death, MI, urgent revascularisation, stent thrombosis, stroke)

PRU ≤85

2nd assessment and adjustment: Verifynow P2Y12 : 2 weeks ± 2 d

85<PRU<208

SLIDE 7

Platelet reactivity and antiplatelet therapy

Control (n=442) Monitoring (n=435)

P-value

Within platelet platelet inhibition target (85<PRU< 208) at day 14 – %

N.D. 41.8%

Within platelet inhibition target (85<PRU< 208) after the last test performed (at

N.D. 66.0%

ANTARCTIC a study by the ACTION Group

(85<PRU< 208) after the last test performed (at day 14 or 28) - % patients

N.D. 66.0%

Final P2Y12 antagonist treatment prasugrel 5 mg – %

92.8% 55.2%

<0.0001

prasugrel 10 mg – %

1.1% 3.7%

clopidogrel 75 mg – %

4.1% 39.3%

No P2Y12 antagonist – %

2.0% 1.8%

SLIDE 8

Primary Endpoint

ANTARCTIC a study by the ACTION Group

CV death, MI, stroke, stent thrombosis, urgent revascularization or BARC 2, 3 or 5

SLIDE 9

Ischemic Endpoint

CV death, MI, stroke, stent thrombosis, urgent revascularization BARC 2,3,5

Bleeding Endpoint

ANTARCTIC a study by the ACTION Group

SLIDE 10

Conclusions

Largest randomized PCI study in the elderly
Platelet function monitoring to adjust antiplatelet therapy in elderly

patients stented for an ACS does not improve their clinical outcomes

ANTARCTIC a study by the ACTION Group

ANTARCTIC after ARCTIC, confirms failure to improve the prognosis of

patients by monitoring platelet function to individualize antiplatelet

therapy. Failure is not related to the risk level of the population or type
f P2Y12 antagonist