The Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial, recently presented at the ESC meeting in Munich, did not show any advantage in using prasugrel over clopidogrel in non-ST elevation (NSTE) ACS patients not treated with revascularization [ 1 ]. The primary endpoint of the study (a composite of cardiovascular death, myocardial infarction and stroke) was not different in the two arms of the trial after a median follow-up period of 17.1 months. The lack of prasugrel benefit was observed in all 9326 randomized patients representing the entire study cohort (including patients aged 75 years or older) as well as in the younger population including 7243 patients for whom the primary endpoint of the study was tested. Since in elderly patients the daily used dose of prasugrel (5 mg) had never been tested before, the analysis in these patients was considered exploratory.
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