Prasugrel dose de-escalation in diabetic patients with acute coronary syndrome receiving percutaneous coronary intervention: results from the HOST-REDUCE-POLYTECH-ACS trial

Kyu Sun Lee; Keun Ho Park; Kyung Woo Park; Seung Woon Rha; Doyeon Hwang; Jeehoon Kang; Jung Kyu Han; Han Mo Yang; Hyun Jae Kang; Bon Kwon Koo; Nam Ho Lee; Jay Young Rhew; Kook Jin Chun; Young Hyo Lim; Jung Min Bong; Jang Whan Bae; Bong Ki Lee; Seok Yeon Kim; Won Yong Shin; Hong Seok Lim; Kyungil Park; Hyo Soo Kim

doi:10.1093/ehjcvp/pvad008

Prasugrel dose de-escalation in diabetic patients with acute coronary syndrome receiving percutaneous coronary intervention: results from the HOST-REDUCE-POLYTECH-ACS trial

Kyu Sun Lee, Keun Ho Park, Kyung Woo Park, Seung Woon Rha, Doyeon Hwang, Jeehoon Kang, Jung Kyu Han, Han Mo Yang, Hyun Jae Kang, Bon Kwon Koo, Nam Ho Lee, Jay Young Rhew, Kook Jin Chun, Young Hyo Lim, Jung Min Bong, Jang Whan Bae, Bong Ki Lee, Seok Yeon Kim, Won Yong Shin, Hong Seok LimKyungil Park, Hyo Soo Kim

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

Aims The aim of this study was to evaluate the efficacy and safety of prasugrel dose de-escalation therapy in patients with diabetes mellitus (DM)–acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods and This was a post-hoc analysis of the HOST-REDUCE-POLYTECH-ACS (Harmonizing Optimal Strategy for Treatment results of Coronary Artery Diseases—Comparison of Reduction of Prasugrel Dose or Polymer Technology in ACS Patients) randomized trial. The efficacy and safety of prasugrel dose de-escalation therapy (prasugrel 5 mg daily) were compared with conventional therapy (prasugrel 10 mg daily) in patients with DM. The primary endpoint was net adverse clinical events (NACE), defined as a composite of all-cause death, non-fatal myocardial infarction (MI), stent thrombosis (ST), clinically driven revascularization, stroke, and Bleeding Academic Research Consortium (BARC) class ≥2 bleeding events. The secondary ischaemic outcome was major adverse cardiovascular and cerebrovascular events, defined as the composite of cardiac death, non-fatal MI, ST, or ischaemic stroke. Of 2338 patients randomized, 990 had DM. The primary endpoint of NACE occurred in 38 patients (7.6%) receiving prasugrel dose de-escalation and in 53 patients (11.3%) receiving conventional therapy among patients with DM [hazard ratio (HR) 0.66; 95% confidence interval (CI) 0.43–0.99; P = 0.049]. Prasugrel dose de-escalation as compared with conventional therapy did not increase the risk of ischaemic events (HR 1.03; 95% CI 0.56–1.88; P = 0.927) but decreased BARC class ≥2 bleeding in patients with DM (HR 0.44; 95% CI 0.23–0.84; P = 0.012). Conclusion Prasugrel dose de-escalation compared with conventional therapy may reduce the risk of net clinical outcomes, mostly driven by a reduction in bleeding without an increase in ischaemic events in patients with DM.

Original language	English
Pages (from-to)	262-270
Number of pages	9
Journal	European Heart Journal - Cardiovascular Pharmacotherapy
Volume	9
Issue number	3
DOIs	https://doi.org/10.1093/ehjcvp/pvad008
Publication status	Published - 2023 Apr 1
Externally published	Yes

Bibliographical note

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.

Keywords

Acute coronary syndrome
De-escalation
Diabetes mellitus
Percutaneous coronary intervention
Prasugrel

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Pharmacology (medical)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/ehjcvp/pvad008

Cite this

Lee, K. S., Park, K. H., Park, K. W., Rha, S. W., Hwang, D., Kang, J., Han, J. K., Yang, H. M., Kang, H. J., Koo, B. K., Lee, N. H., Rhew, J. Y., Chun, K. J., Lim, Y. H., Bong, J. M., Bae, J. W., Lee, B. K., Kim, S. Y., Shin, W. Y., ... Kim, H. S. (2023). Prasugrel dose de-escalation in diabetic patients with acute coronary syndrome receiving percutaneous coronary intervention: results from the HOST-REDUCE-POLYTECH-ACS trial. European Heart Journal - Cardiovascular Pharmacotherapy, 9(3), 262-270. https://doi.org/10.1093/ehjcvp/pvad008

Prasugrel dose de-escalation in diabetic patients with acute coronary syndrome receiving percutaneous coronary intervention: results from the HOST-REDUCE-POLYTECH-ACS trial. / Lee, Kyu Sun; Park, Keun Ho; Park, Kyung Woo et al.
In: European Heart Journal - Cardiovascular Pharmacotherapy, Vol. 9, No. 3, 01.04.2023, p. 262-270.

Research output: Contribution to journal › Article › peer-review

Lee, KS, Park, KH, Park, KW, Rha, SW, Hwang, D, Kang, J, Han, JK, Yang, HM, Kang, HJ, Koo, BK, Lee, NH, Rhew, JY, Chun, KJ, Lim, YH, Bong, JM, Bae, JW, Lee, BK, Kim, SY, Shin, WY, Lim, HS, Park, K & Kim, HS 2023, 'Prasugrel dose de-escalation in diabetic patients with acute coronary syndrome receiving percutaneous coronary intervention: results from the HOST-REDUCE-POLYTECH-ACS trial', European Heart Journal - Cardiovascular Pharmacotherapy, vol. 9, no. 3, pp. 262-270. https://doi.org/10.1093/ehjcvp/pvad008

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title = "Prasugrel dose de-escalation in diabetic patients with acute coronary syndrome receiving percutaneous coronary intervention: results from the HOST-REDUCE-POLYTECH-ACS trial",

abstract = "Aims The aim of this study was to evaluate the efficacy and safety of prasugrel dose de-escalation therapy in patients with diabetes mellitus (DM)–acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods and This was a post-hoc analysis of the HOST-REDUCE-POLYTECH-ACS (Harmonizing Optimal Strategy for Treatment results of Coronary Artery Diseases—Comparison of Reduction of Prasugrel Dose or Polymer Technology in ACS Patients) randomized trial. The efficacy and safety of prasugrel dose de-escalation therapy (prasugrel 5 mg daily) were compared with conventional therapy (prasugrel 10 mg daily) in patients with DM. The primary endpoint was net adverse clinical events (NACE), defined as a composite of all-cause death, non-fatal myocardial infarction (MI), stent thrombosis (ST), clinically driven revascularization, stroke, and Bleeding Academic Research Consortium (BARC) class ≥2 bleeding events. The secondary ischaemic outcome was major adverse cardiovascular and cerebrovascular events, defined as the composite of cardiac death, non-fatal MI, ST, or ischaemic stroke. Of 2338 patients randomized, 990 had DM. The primary endpoint of NACE occurred in 38 patients (7.6%) receiving prasugrel dose de-escalation and in 53 patients (11.3%) receiving conventional therapy among patients with DM [hazard ratio (HR) 0.66; 95% confidence interval (CI) 0.43–0.99; P = 0.049]. Prasugrel dose de-escalation as compared with conventional therapy did not increase the risk of ischaemic events (HR 1.03; 95% CI 0.56–1.88; P = 0.927) but decreased BARC class ≥2 bleeding in patients with DM (HR 0.44; 95% CI 0.23–0.84; P = 0.012). Conclusion Prasugrel dose de-escalation compared with conventional therapy may reduce the risk of net clinical outcomes, mostly driven by a reduction in bleeding without an increase in ischaemic events in patients with DM.",

keywords = "Acute coronary syndrome, De-escalation, Diabetes mellitus, Percutaneous coronary intervention, Prasugrel",

author = "Lee, {Kyu Sun} and Park, {Keun Ho} and Park, {Kyung Woo} and Rha, {Seung Woon} and Doyeon Hwang and Jeehoon Kang and Han, {Jung Kyu} and Yang, {Han Mo} and Kang, {Hyun Jae} and Koo, {Bon Kwon} and Lee, {Nam Ho} and Rhew, {Jay Young} and Chun, {Kook Jin} and Lim, {Young Hyo} and Bong, {Jung Min} and Bae, {Jang Whan} and Lee, {Bong Ki} and Kim, {Seok Yeon} and Shin, {Won Yong} and Lim, {Hong Seok} and Kyungil Park and Kim, {Hyo Soo}",

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doi = "10.1093/ehjcvp/pvad008",

language = "English",

volume = "9",

pages = "262--270",

journal = "European Heart Journal - Cardiovascular Pharmacotherapy",

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TY - JOUR

T1 - Prasugrel dose de-escalation in diabetic patients with acute coronary syndrome receiving percutaneous coronary intervention

T2 - results from the HOST-REDUCE-POLYTECH-ACS trial

AU - Lee, Kyu Sun

AU - Park, Keun Ho

AU - Park, Kyung Woo

AU - Rha, Seung Woon

AU - Hwang, Doyeon

AU - Kang, Jeehoon

AU - Han, Jung Kyu

AU - Yang, Han Mo

AU - Kang, Hyun Jae

AU - Koo, Bon Kwon

AU - Lee, Nam Ho

AU - Rhew, Jay Young

AU - Chun, Kook Jin

AU - Lim, Young Hyo

AU - Bong, Jung Min

AU - Bae, Jang Whan

AU - Lee, Bong Ki

AU - Kim, Seok Yeon

AU - Shin, Won Yong

AU - Lim, Hong Seok

AU - Park, Kyungil

AU - Kim, Hyo Soo

PY - 2023/4/1

Y1 - 2023/4/1

N2 - Aims The aim of this study was to evaluate the efficacy and safety of prasugrel dose de-escalation therapy in patients with diabetes mellitus (DM)–acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods and This was a post-hoc analysis of the HOST-REDUCE-POLYTECH-ACS (Harmonizing Optimal Strategy for Treatment results of Coronary Artery Diseases—Comparison of Reduction of Prasugrel Dose or Polymer Technology in ACS Patients) randomized trial. The efficacy and safety of prasugrel dose de-escalation therapy (prasugrel 5 mg daily) were compared with conventional therapy (prasugrel 10 mg daily) in patients with DM. The primary endpoint was net adverse clinical events (NACE), defined as a composite of all-cause death, non-fatal myocardial infarction (MI), stent thrombosis (ST), clinically driven revascularization, stroke, and Bleeding Academic Research Consortium (BARC) class ≥2 bleeding events. The secondary ischaemic outcome was major adverse cardiovascular and cerebrovascular events, defined as the composite of cardiac death, non-fatal MI, ST, or ischaemic stroke. Of 2338 patients randomized, 990 had DM. The primary endpoint of NACE occurred in 38 patients (7.6%) receiving prasugrel dose de-escalation and in 53 patients (11.3%) receiving conventional therapy among patients with DM [hazard ratio (HR) 0.66; 95% confidence interval (CI) 0.43–0.99; P = 0.049]. Prasugrel dose de-escalation as compared with conventional therapy did not increase the risk of ischaemic events (HR 1.03; 95% CI 0.56–1.88; P = 0.927) but decreased BARC class ≥2 bleeding in patients with DM (HR 0.44; 95% CI 0.23–0.84; P = 0.012). Conclusion Prasugrel dose de-escalation compared with conventional therapy may reduce the risk of net clinical outcomes, mostly driven by a reduction in bleeding without an increase in ischaemic events in patients with DM.

AB - Aims The aim of this study was to evaluate the efficacy and safety of prasugrel dose de-escalation therapy in patients with diabetes mellitus (DM)–acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods and This was a post-hoc analysis of the HOST-REDUCE-POLYTECH-ACS (Harmonizing Optimal Strategy for Treatment results of Coronary Artery Diseases—Comparison of Reduction of Prasugrel Dose or Polymer Technology in ACS Patients) randomized trial. The efficacy and safety of prasugrel dose de-escalation therapy (prasugrel 5 mg daily) were compared with conventional therapy (prasugrel 10 mg daily) in patients with DM. The primary endpoint was net adverse clinical events (NACE), defined as a composite of all-cause death, non-fatal myocardial infarction (MI), stent thrombosis (ST), clinically driven revascularization, stroke, and Bleeding Academic Research Consortium (BARC) class ≥2 bleeding events. The secondary ischaemic outcome was major adverse cardiovascular and cerebrovascular events, defined as the composite of cardiac death, non-fatal MI, ST, or ischaemic stroke. Of 2338 patients randomized, 990 had DM. The primary endpoint of NACE occurred in 38 patients (7.6%) receiving prasugrel dose de-escalation and in 53 patients (11.3%) receiving conventional therapy among patients with DM [hazard ratio (HR) 0.66; 95% confidence interval (CI) 0.43–0.99; P = 0.049]. Prasugrel dose de-escalation as compared with conventional therapy did not increase the risk of ischaemic events (HR 1.03; 95% CI 0.56–1.88; P = 0.927) but decreased BARC class ≥2 bleeding in patients with DM (HR 0.44; 95% CI 0.23–0.84; P = 0.012). Conclusion Prasugrel dose de-escalation compared with conventional therapy may reduce the risk of net clinical outcomes, mostly driven by a reduction in bleeding without an increase in ischaemic events in patients with DM.

KW - Acute coronary syndrome

KW - De-escalation

KW - Diabetes mellitus

KW - Percutaneous coronary intervention

KW - Prasugrel

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SN - 2055-6837

VL - 9

SP - 262

EP - 270

JO - European Heart Journal - Cardiovascular Pharmacotherapy

JF - European Heart Journal - Cardiovascular Pharmacotherapy

IS - 3

ER -

Prasugrel dose de-escalation in diabetic patients with acute coronary syndrome receiving percutaneous coronary intervention: results from the HOST-REDUCE-POLYTECH-ACS trial

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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