A 60-year-old woman presents 2 hours after chest pain onset. ECG shows 3 mm ST elevation in V1–V4. She is taken for primary PCI. Which P2Y12 inhibitor is preferred over clopidogrel in this setting according to ESC STEMI guidelines?

• A Clopidogrel, as it has the best safety record
• B Prasugrel, which is preferred in all patients over clopidogrel
• C Vorapaxar, as it provides faster platelet inhibition
• D Ticagrelor, based on PLATO trial showing superiority over clopidogrel ✓

Explanation

Ticagrelor is preferred over clopidogrel in STEMI/ACS based on the PLATO trial, which showed reduced death, MI, and stroke without significant increase in major bleeding. Prasugrel is also superior to clopidogrel but is contraindicated in patients with prior stroke/TIA, age >75, or weight <60 kg. Vorapaxar is a PAR-1 antagonist added to standard therapy and is not a first-line agent.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.