Clinical Effectiveness and Safety of Reduced-Dose Prasugrel in Asian Patients: The PROMISE-TW Registry

<b>Background:</b> Reduced-dose prasugrel is widely used in East Asia for acute coronary syndrome (ACS), but real-world data in diverse Asian populations are limited. This study evaluated its effectiveness and safety in Taiwanese patients. <b>Methods:</b> The PROMISE-TW Registry was a multicenter, retrospective study including 1167 patients with ACS or chronic coronary syndrome (CCS) treated with reduced-dose prasugrel (20 mg loading, 3.75 mg maintenance) across 13 hospitals in Taiwan from 2018 to 2022. The primary endpoint was 1-year major adverse cardiovascular events (MACEs: cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke). Secondary outcomes included composite ischemic events and major bleeding (BARC 3-5). <b>Results:</b> Among enrolled patients (mean age 63.9 years; 81.2% male; 83% ACS), percutaneous coronary intervention was performed in 90.8%. At one year, MACEs occurred in 1.9%, composite ischemic events in 8.2%, and major bleeding in 0.8%. Subgroup analysis identified prior stroke, diabetes, and chronic total occlusion intervention as predictors of bleeding. Male sex, chronic kidney disease, and left circumflex artery intervention predicted higher ischemic risk. <b>Conclusions:</b>Reduced-dose prasugrel provided effective ischemic protection and low bleeding rates in Taiwanese patients, especially those with ACS. These findings support the clinical utility of dose-adjusted prasugrel in East Asian populations and highlight the importance of individualized risk assessment.

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Publication Details

Journal
Journal of Clinical Medicine
Published
2025-08-15
DOI
https://doi.org/10.3390/jcm14165791
Citations
1
Primary Topic
Antiplatelet Therapy and Cardiovascular Diseases
Type
article
Field-Weighted Citation Impact
1.39

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article

Clinical Effectiveness and Safety of Reduced-Dose Prasugrel in Asian Patients: The PROMISE-TW Registry

Kuan‐Cheng Chang, Wen-Lieng Lee, Ho‐Ming Su, Chih-Chang Yu et al.
1 citations
Journal of Clinical Medicine
Antiplatelet Therapy and Cardiovascular Diseases
1.39
article

Clinical Effectiveness and Safety of Reduced-Dose Prasugrel in Asian Patients: The PROMISE-TW Registry

Kuan‐Cheng Chang, Wen-Lieng Lee, Ho‐Ming Su, Chih-Chang Yu, Yi-Tzone Shiao, Chiung-Ray Lu, Wei-Shin Liu, Ming‐Jer Hsieh, Po‐Chih Lin, Yu-Chen Wang, Chun‐Hung Su, Chien-Lung Huang, Yu‐Wei Chiu, Ye‐Hsu Lu, Hsin-Bang Leu
article en
1 citations

Abstract

<b>Background:</b> Reduced-dose prasugrel is widely used in East Asia for acute coronary syndrome (ACS), but real-world data in diverse Asian populations are limited. This study evaluated its effectiveness and safety in Taiwanese patients. <b>Methods:</b> The PROMISE-TW Registry was a multicenter, retrospective study including 1167 patients with ACS or chronic coronary syndrome (CCS) treated with reduced-dose prasugrel (20 mg loading, 3.75 mg maintenance) across 13 hospitals in Taiwan from 2018 to 2022. The primary endpoint was 1-year major adverse cardiovascular events (MACEs: cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke). Secondary outcomes included composite ischemic events and major bleeding (BARC 3-5). <b>Results:</b> Among enrolled patients (mean age 63.9 years; 81.2% male; 83% ACS), percutaneous coronary intervention was performed in 90.8%. At one year, MACEs occurred in 1.9%, composite ischemic events in 8.2%, and major bleeding in 0.8%. Subgroup analysis identified prior stroke, diabetes, and chronic total occlusion intervention as predictors of bleeding. Male sex, chronic kidney disease, and left circumflex artery intervention predicted higher ischemic risk. <b>Conclusions:</b>Reduced-dose prasugrel provided effective ischemic protection and low bleeding rates in Taiwanese patients, especially those with ACS. These findings support the clinical utility of dose-adjusted prasugrel in East Asian populations and highlight the importance of individualized risk assessment.

Journal of Clinical MedicineVol. 14(16)
Asia University (TW), National Yang Ming Chiao Tung University (TW), Kaohsiung Medical University (TW), National Chung Hsing University (TW), Chang Gung University (TW), China Medical University (TW), Tzu Chi Foundation (TW), Kaohsiung Medical University Chung-Ho Memorial Hospital (TW), Taipei Veterans General Hospital (TW), Chang Gung Memorial Hospital (TW), Taichung Veterans General Hospital (TW), Cheng Hsin General Hospital (TW), Far Eastern Memorial Hospital (TW), Chung Shan Medical University Hospital (TW), Hualien Tzu Chi Medical Center (TW), China Medical University Hospital (TW), National Taiwan University Hospital (TW), Kaohsiung Municipal Hsiao-Kang Hospital (TW), Tainan Municipal Hospital (TW), Chihlee Institute of Technology (TW), Chung Shan Medical University (TW), Yuan Ze University (TW)
Daiichi-Sankyo, China Medical University Hospital, China Medical University, Daiichi Sankyo Europe
Good health and well-being
Openalex Percentile: Top 16%
Antiplatelet Therapy and Cardiovascular Diseases
1.39
DOIOpen Access PDFOpenAlex
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