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Ticagrelor or Prasugrel in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous
Alp Aytekin1, Gjin Ndrepepa1, Franz-Josef Neumann2
1Deutsches Herzzentrum München, Cardiology and Technische Universität München, Munich, Germany (A.A., G.N., K.M., S.L., S.C., S.K., E.X., H.B.S., M.J., M.F., H.S., S.S., A.K).
Insights
In ST-segment-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention, ticagrelor and prasugrel showed similar efficacy. However, ticagrelor was linked to a higher risk of recurrent myocardial infarction compared to prasugrel.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Limited data exist on ticagrelor vs. prasugrel in ST-segment-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
- This study provides a head-to-head comparison of these antiplatelet agents in a specific high-risk patient population.
Purpose of the Study:
- To compare the efficacy and safety of ticagrelor versus prasugrel in STEMI patients undergoing primary PCI.
- To assess the rates of major adverse cardiovascular events and bleeding between the two treatment groups.
Main Methods:
- A subgroup analysis of 1653 STEMI patients from the ISAR REACT-5 trial was conducted.
- Patients were randomized to receive either ticagrelor or prasugrel.
- Primary endpoint: death, myocardial infarction, or stroke at 1 year. Secondary endpoint: Bleeding Academic Research Consortium (BARC) type 3-5 bleeding at 1 year.
Main Results:
- No significant difference was observed in the primary endpoint (composite of death, MI, or stroke) between ticagrelor and prasugrel groups (10.1% vs. 7.9%, P=0.10).
- Ticagrelor was associated with a significantly higher incidence of myocardial infarction compared to prasugrel (5.3% vs. 2.8%, P=0.010).
- Rates of death, stroke, stent thrombosis, and BARC type 3-5 bleeding did not differ significantly between the groups.
Conclusions:
- In STEMI patients undergoing primary PCI, prasugrel and ticagrelor demonstrated comparable overall efficacy regarding the primary composite endpoint.
- Ticagrelor use was associated with an increased risk of recurrent myocardial infarction.
- The choice between ticagrelor and prasugrel in this setting warrants careful consideration of individual patient risk factors.
Background:
Data on the comparative efficacy and safety of ticagrelor versus prasugrel in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention are limited. We assessed the efficacy and safety of ticagrelor versus prasugrel in a head-to-head comparison in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Methods:
In this prespecified subgroup analysis, we included 1653 patients with ST-segment-elevation myocardial infarction randomized to receive ticagrelor or prasugrel in the setting of the ISAR REACT-5 trial (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 5). The primary end point was the incidence of death, myocardial infarction, or stroke at 1 year after randomization. The secondary end point was the incidence of bleeding defined as BARC (Bleeding Academic Research Consortium) type 3 to 5 bleeding at 1 year after randomization.
Results:
The primary end point occurred in 83 patients (10.1%) in the ticagrelor group and in 64 patients (7.9%) in the prasugrel group (hazard ratio, 1.31 [95% CI, 0.95-1.82]; P=0.10). One-year incidence of all-cause death (4.9% versus 4.7%; P=0.83), stroke (1.3% versus 1.0%; P=0.46), and definite stent thrombosis (1.8% versus 1.0%; P=0.15) did not differ significantly in patients assigned to ticagrelor or prasugrel. One-year incidence of myocardial infarction (5.3% versus 2.8%; hazard ratio, 1.95 [95% CI, 1.18-3.23]; P=0.010) was higher with ticagrelor than with prasugrel. BARC type 3 to 5 bleeding occurred in 46 patients (6.1%) in the ticagrelor group and in 39 patients (5.1%) in the prasugrel group (hazard ratio, 1.22 [95% CI, 0.80-1.87]; P=0.36).
Conclusions:
In patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, there was no significant difference in the primary end point between prasugrel and ticagrelor. Ticagrelor was associated with a significant increase in the risk for recurrent myocardial infarction. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01944800.
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