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Ticagrelor vs Prasugrel in a Contemporary Real-World Cohort Undergoing Percutaneous Coronary Intervention
Anoop N Koshy1, Gennaro Giustino2, Samantha Sartori2
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Cardiology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
Insights
Ticagrelor and prasugrel showed similar 1-year efficacy and safety in patients undergoing percutaneous coronary intervention (PCI). These potent P2Y12 agents are widely used, but data comparing them in acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) patients were limited.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Potent P2Y12 inhibitors, ticagrelor and prasugrel, are frequently used in percutaneous coronary intervention (PCI).
- Limited data exist comparing their efficacy and safety in patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS).
Purpose of the Study:
- To compare the real-world efficacy and safety of ticagrelor versus prasugrel in patients undergoing PCI.
- To evaluate outcomes in a contemporary PCI cohort including both ACS and CCS patients.
Main Methods:
- A prospective institutional PCI registry was used to identify patients discharged on ticagrelor or prasugrel between 2014 and 2019.
- The primary endpoint was a composite of death and myocardial infarction (MI) at 1 year.
- Secondary outcomes included bleeding, stroke, and target vessel revascularization rates.
Main Results:
- No significant difference in the composite endpoint of death or MI was observed between ticagrelor and prasugrel (3.3% vs 3.1%).
- Ticagrelor use was associated with significantly lower rates of target vessel revascularization compared to prasugrel (9.3% vs 14.0%).
- No differences in stroke or bleeding rates were found between the two agents, with consistent findings across ACS and CCS subgroups.
Conclusions:
- Ticagrelor and prasugrel demonstrated similar 1-year efficacy and safety profiles in a real-world PCI population.
- The findings support the use of both agents in contemporary PCI patients, including those with ACS and CCS.
Background:
Potent P2Y12 agents such as ticagrelor and prasugrel are increasingly utilized across the clinical spectrum of patients undergoing percutaneous coronary intervention (PCI). There is a paucity of data supporting their use in a patient population inclusive of both acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) patients.
Objectives:
The authors compared the efficacy and safety of ticagrelor and prasugrel in a real-world contemporary PCI cohort.
Methods:
Consecutive patients undergoing PCI between 2014 and 2019 discharged on either prasugrel or ticagrelor were included from the prospectively collected institutional PCI registry. Primary endpoint was the composite of death and myocardial infarction (MI), with secondary outcomes including rates of bleeding, stroke, and target vessel revascularization at 1 year.
Results:
Overall, 3,858 patients were included in the study (ticagrelor: n = 2,771; prasugrel: n = 1,087), and a majority (48.4%) underwent PCI in the context of CCS. Patients prescribed ticagrelor were more likely to be female, have a history of cerebrovascular disease, and have ACS presentation, while those receiving prasugrel were more likely to be White with a higher prevalence of prior revascularization. No difference in the risk of death or MI was noted across the groups (ticagrelor vs prasugrel: 3.3% vs 3.1%; HR: 0.88; 95% CI: 0.54-1.43; P = 0.59). Rates of target vessel revascularization were significantly lower in the ticagrelor cohort (9.3% vs 14.0%; adjusted HR: 0.71; 95% CI: 0.55-0.91; P = 0.007) with no differences in stroke or bleeding. The results were consistent in patients with CCS (HR: 0.84; 95% CI: 0.46-1.54) and ACS (HR: 1.18; 95% CI: 0.46-1.54), without evidence of interaction (P = 0.37), and confirmed across multivariable adjustment and propensity score stratification analysis.
Conclusions:
In this contemporary patient population undergoing PCI, prasugrel and ticagrelor were associated with similar 1-year efficacy and safety.
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