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Multiple Types of Heart Attacks Reduced by Prasugrel in TRITON-TIMI 38 Trial
Date:5/21/2009

orrow, M.D. M.P.H., Associate Professor of Medicine at Harvard Medical School and a Senior Investigator with the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.

Investigators classified 1,218 heart attacks that occurred during the TRITON-TIMI 38 study based on the Universal Definition of Myocardial Infarction. This definition includes a new classification system to characterize different types of heart attacks based on the size and type of heart attack.(3) The types of heart attacks evaluated in this study, according to the definition, included:

  • Type 1: Spontaneous heart attack caused by a primary coronary event, such as a plaque rupture in a coronary artery with less blood then flowing to the muscle
  • Type 2: Secondary heart attack due to either increased oxygen demand or decreased supply due to other conditions such as spasm of the coronary artery or low blood oxygen from anemia
  • Type 3: Sudden cardiac death with evidence of a heart attack
  • Type 4: Heart attacks related to a PCI
    • Type 4a: Heart attacks associated with a PCI procedure
    • Type 4b: Heart attacks associated with stent thrombosis as documented by an angiography or at autopsy
  • Type 5: Heart attack associated with coronary artery bypass graft (CABG).

The investigators examined the size and timing of a new heart attack, as well as whether or not the heart attack was associated with an elevation of the ST segment on the electrocardiogram (noted as STEMI and NSTEMI).

The results of the analysis showed:

  • The rate of spontaneous heart attacks (Type 1) was 2.5 percent in patients taking prasugrel compared with 3.4 percent in those taking clopidogrel (p=0.0
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SOURCE Eli Lilly and Company
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