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Ticagrelor versus Prasugrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention:

Ran Eliaz1, Bethlehem Mengesha2,3, Tal Ovdat4

  • 1Department of Cardiology, Hadassah Medical Center, Israel and the Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel.

Cardiology
|November 22, 2021
PubMed

Insights

Prasugrel showed better outcomes than ticagrelor for ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention. For non-ST-elevation acute coronary syndrome (NSTE-ACS) patients, drug choice did not significantly impact outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Acute coronary syndrome (ACS) requires prompt treatment with antiplatelet agents.
  • Prasugrel and ticagrelor are P2Y12 inhibitors used in ACS management.
  • Comparative effectiveness data for these agents in real-world settings is crucial.

Purpose of the Study:

  • To compare clinical outcomes of ACS patients treated with prasugrel versus ticagrelor post-percutaneous coronary intervention.
  • To evaluate the impact of drug choice on in-hospital complications, re-hospitalization, and mortality.

Main Methods:

  • Retrospective analysis of 1,126 patients on prasugrel and 817 on ticagrelor from the ACSIS registry (2010-2018).
  • Comparisons performed in ST-elevation myocardial infarction (STEMI) and non-ST-elevation ACS (NSTE-ACS) subgroups.
  • Propensity score matching (PSM) used for STEMI patients; Cox regression analysis for the entire cohort.

Main Results:

  • No significant difference in in-hospital complications or stent thrombosis between prasugrel and ticagrelor groups.
  • In PSM STEMI patients, ticagrelor was associated with higher 30-day re-hospitalization, 30-day Major Adverse Cardiovascular Events (MACE), and 1-year mortality.
  • In NSTE-ACS patients, outcomes were not significantly different based on drug choice.

Conclusions:

  • Prasugrel demonstrated superior clinical outcomes compared to ticagrelor specifically in STEMI patients undergoing percutaneous coronary intervention.
  • No significant difference in outcomes was observed between prasugrel and ticagrelor in the NSTE-ACS patient subgroup.
  • The choice of P2Y12 inhibitor may have differential impacts depending on the ACS subtype.
Abstract

Keywords:
Acute coronary syndromePercutaneous coronary interventionPrasugrelTicagrelor

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