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effect of antiplatelet agents is important to further improve the outcome of PCI. Prasugrel is a newer generation P2Y12 receptor antagonist that has faster metabolism after intake and lower inter-individual variability in platelet response than clopidogrel. Prasugrel was shown to reduce ischemic events but to increase bleeding complications in the TRITON TIMI-38 trial.4 Prudent dose adjustment has been performed for its introduction to the Japanese patients. Pivotal trials such as Prasfit ACS5 and Prasfit elective6 for Japanese approval demonstrated equivalent incidence of bleeding complications and lower incidence of periprocedural MI than with clopidogrel. A dose of 3.75 mg daily is P ercutaneous coronary intervention (PCI) plays a leading role in the treatment of coronary artery disease (CAD). PCI always requires dual periprocedural antithrombotic agents (so-called DAPT [dual antiplatelet therapy]) to avoid coronary events such as stent thrombosis (ST) and myocardial infarction (MI). Historically, rates of ST while using aspirin and warfarin were around 3%, and DAPT decreased this to less than 1%.1 Therefore, the concept that anticoagulation is inappropriate for the prevention of ST was established among cardiologists at the time of coronary stent introduction. Recently, the risk of ST has been dramatically decreased with the use of newer generation drug-eluting stents.2 However, it is still common knowledge that ST and periprocedural MI mostly occur on the first day of PCI.3 In this regard, the rapid Article p 1000

A Main Performer May Come for Percutaneous Coronary Intervention With Atrial Fibrillation in Japanese Patients