Incidence and pattern of urgent revascularization in acute coronary syndromes treated with ticagrelor or prasugrel
Alp Aytekin1, Maria Scalamogna1, J J Coughlan2
1Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany.
Insights
Ticagrelor use in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) was associated with a higher rate of urgent revascularization compared to prasugrel. This increase was primarily driven by non-target vessel revascularization events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- The ISAR-REACT 5 trial previously compared ticagrelor and prasugrel in invasive management of acute coronary syndromes (ACS).
- Urgent revascularization is a critical outcome in ACS patients post-percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate the impact of ticagrelor versus prasugrel on the incidence and pattern of urgent revascularization in ACS patients undergoing PCI.
- To analyze differences in urgent target vessel revascularization (TVR) and non-target vessel revascularization (NTVR) between the two drug groups.
Main Methods:
- Post-hoc analysis of the ISAR-REACT 5 trial data.
- Included 3,377 ACS patients who underwent PCI, with 1,676 assigned to ticagrelor and 1,701 to prasugrel.
- Primary endpoint: incidence of urgent revascularization at 12-month follow-up. Secondary endpoint: pattern of urgent TVR/NTVR.
Main Results:
- The incidence of urgent revascularization at 12 months was higher with ticagrelor (6.8%) compared to prasugrel (5.2%) (HR=1.32, p=0.051).
- This difference was mainly due to a significant increase in urgent non-target vessel revascularization (NTVR) in the ticagrelor group (3.8% vs. 2.4%; HR=1.62, p=0.017).
- The risk of urgent target vessel revascularization (TVR) did not significantly differ between the groups (3.3% vs. 3.0%; HR=1.13, p=0.546).
Conclusions:
- In ACS patients treated with PCI, ticagrelor is associated with a higher cumulative rate of urgent revascularizations at 12 months compared to prasugrel.
- The increased rate is primarily driven by urgent revascularizations involving coronary vessels remote from the initially treated site (NTVR).
- These findings highlight potential differences in the effectiveness of ticagrelor and prasugrel concerning revascularization patterns in ACS patients.
Background:
The ISAR-REACT 5 trial compared the efficacy and safety of ticagrelor and prasugrel in patients with ACS managed invasively. The present study sought to investigate the impact of ticagrelor and prasugrel on the incidence and pattern of urgent revascularization in acute coronary syndromes (ACS) patients undergoing percutaneous coronary intervention (PCI).
Methods And Results:
This post-hoc analysis of the ISAR-REACT 5 trial included all ACS patients who underwent PCI. The primary endpoint for this analysis was the incidence of urgent revascularization at 12-month follow-up. Secondary outcome was the pattern of urgent revascularization procedures (namely, urgent target vessel/non-target vessel revascularization - TVR/NTVR). Among 3,377 ACS patients who underwent PCI, 1,676 were assigned to ticagrelor and 1,701 to prasugrel before PCI. After 12 months, the incidence of urgent revascularization was higher among patients assigned to ticagrelor as compared to prasugrel (6.8% vs. 5.2%; hazard ratio [HR] = 1.32, 95% confidence interval [CI] 1.00-1.75; p = 0.051), mostly attributable to significantly more urgent NTVR in the ticagrelor group (3.8% vs. 2.4%; HR = 1.62 [1.09-2.41]; p = 0.017). The risk of urgent TVR did not differ between treatment groups (3.3% vs. 3.0%; HR = 1.13 [0.77-1.65]; p = 0.546).
Conclusions:
In ACS patients treated with PCI, the cumulative rate of urgent revascularizations after 12 months is higher with ticagrelor compared to prasugrel, due to a significant increase in urgent revascularizations involving remote coronary vessels.
