Reduction of in-stent thrombus immediately after percutaneous coronary intervention by pretreatment with prasugrel compared with clopidogrel: An optical coherence tomography study

Abstract

Background: Prasugrel is a new-generation thienopyridine antiplatelet agent that provides more consistent and prompt platelet inhibition than clopidogrel. The aim of this study was to compare in-stent thrombus inhibition effect of pretreatment with prasugrel and clopidogrel by using optical coherence tomography (OCT) immediately after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).

Methods: We performed OCT immediately after PCI in 108 ACS patients pretreated with either prasugrel (n=51) or clopidogrel (n=57). OCT detected thrombus/plaque protrusion in all stented segments.

Results: Although stent volume (190.4±119.1mm³ vs. 189.4±95.8mm³, p=0.961), mean stent area (6.9±2.9mm² vs. 7.1±2.0mm², p=0.772), and minimum stent area (5.6±2.7mm² vs. 5.4±1.7mm², p=0.554) were not different between the two groups, in-stent thrombus/plaque protrusion volume (1.8±2.9mm³ vs. 4.5±5.3mm³, p=0.002), mean in-stent thrombus/plaque protrusion area (0.1±0.1mm² vs. 0.2±0.2mm², p=0.005), and maximum in-stent thrombus/plaque protrusion area (0.5±0.7mm² vs. 0.8±0.6mm², p=0.007) were significantly smaller in the prasugrel group compared with the clopidogrel group.

Conclusions: Pretreatment with prasugrel was associated with significantly reduced in-stent thrombus/plaque protrusion immediately after PCI for ACS compared with that with clopidogrel.

Keywords: Acute coronary syndrome; Optical coherence tomography; Prasugrel; Stent; Thrombus.