TY - JOUR T1 - Early clinical outcomes as a function of use of newer oral P2Y<sub>12</sub> inhibitors versus clopidogrel in the EUROMAX trial JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2017-000677 VL - 4 IS - 2 SP - e000677 AU - Kurt Huber AU - Gregory Ducrocq AU - Christian W Hamm AU - Arnoud van ’t Hof AU - Frédéric Lapostolle AU - Pierre Coste AU - Giovanni Gordini AU - Jacob Steinmetz AU - Freek W A Verheugt AU - Jennifer Adgey AU - Lutz Nibbe AU - Vojko Kaniĉ AU - Peter Clemmensen AU - Uwe Zeymer AU - Debra Bernstein AU - Jayne Prats AU - Efthymios N Deliargyris AU - Ph Gabriel Steg Y1 - 2017/11/01 UR - http://openheart.bmj.com/content/4/2/e000677.abstract N2 - Objective To ascertain whether different oral P2Y12 inhibitors might affect rates of acute stent thrombosis and 30-day outcomes after primary percutaneous coronary intervention (pPCI).Methods The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) randomised trial compared prehospital bivalirudin with heparin with optional glycoprotein IIb/IIIa inhibitor treatment in patients with ST-segment elevation myocardial infarction triaged to pPCI. Choice of P2Y12 inhibitor was at the investigator’s discretion. In a prespecified analysis, we compared event rates with clopidogrel and newer oral P2Y12 inhibitors (prasugrel, ticagrelor). Rates of the primary outcome (acute stent thrombosis) were examined as a function of the P2Y12 inhibitor used for loading and 30-day outcomes (including major adverse cardiac events) as a function of the P2Y12 inhibitor used for maintenance therapy. Logistic regression was used to adjust for differences in baseline characteristics.Results Prasugrel or ticagrelor was given as the loading P2Y12 inhibitor in 49% of 2198 patients and as a maintenance therapy in 59%. No differences were observed in rates of acute stent thrombosis for clopidogrel versus newer P2Y12 inhibitors (adjusted OR 0.50, 95% CI 0.13 to 1.85). After adjustment, no difference was observed in 30-day outcomes according to maintenance therapy except for protocol major (p=0.029) or minor (p=0.025) bleeding and Thrombolysis In Myocardial Infarction minor bleeding (p=0.002), which were less frequent in patients on clopidogrel. Consistent results were observed in the bivalirudin and heparin arms.Conclusions The choice of prasugrel or ticagrelor over clopidogrel was not associated with differences in acute stent thrombosis or 30-day ischaemic outcomes after pPCI.Trial registration number NCT01087723. ER -