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Ticagrelor o Prasugrel en pacientes con infarto de miocardio por elevación del segmento ST sometidos a intervención

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).

Circulation
|October 29, 2020
PubMed
Resumen
Este resumen es generado por máquina.

En pacientes con infarto de miocardio por elevación del segmento ST sometidos a intervención coronaria percutánea primaria, el ticagrelor y el prasugrel mostraron una eficacia similar. Sin embargo, el ticagrelor se relacionó con un mayor riesgo de infarto de miocardio recurrente en comparación con el prasugrel.

Palabras clave:
Antagonistas de los receptores P2Y12Infarto de miocardio por elevación del SThemorragia en el cuerpola mortalidadIntervención coronaria por la pielClorhidrato de prasugrelTrombosisy el ticagrelor

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Área de la Ciencia:

  • Cardiología
  • Cardiología intervencionista
  • Farmacología

Sus antecedentes:

  • Existen datos limitados sobre el ticagrelor frente al prasugrel en pacientes con infarto de miocardio por elevación del segmento ST sometidos a intervención coronaria percutánea primaria (ICP).
  • Este estudio proporciona una comparación directa de estos agentes antiplaquetarios en una población específica de pacientes de alto riesgo.

Objetivo del estudio:

  • Comparar la eficacia y la seguridad del ticagrelor frente al prasugrel en pacientes con ITST sometidos a ICP primaria.
  • Evaluar las tasas de eventos adversos cardiovasculares importantes y sangrado entre los dos grupos de tratamiento.

Principales métodos:

  • Se realizó un análisis de subgrupos de 1653 pacientes con STEMI del ensayo ISAR REACT-5.
  • Los pacientes fueron asignados al azar para recibir ticagrelor o prasugrel.
  • Objetivo primario: muerte, infarto de miocardio o accidente cerebrovascular al año. Endpoint secundario: hemorragia de tipo 3 a 5 del Consorcio de Investigación Académica (BARC) al año 1.

Principales resultados:

  • No se observaron diferencias significativas en el criterio de valoración primario (morte compuesta, infarto cerebral o accidente cerebrovascular) entre los grupos de ticagrelor y prasugrel (10,1% frente a 7,9%, P=0,10).
  • El ticagrelor se asoció con una incidencia significativamente mayor de infarto de miocardio en comparación con el prasugrel (5,3% frente a 2,8%, P=0,010).
  • Las tasas de mortalidad, accidente cerebrovascular, trombosis de stent y hemorragia tipo 3- 5 BARC no diferían significativamente entre los grupos.

Conclusiones:

  • En pacientes con ITST sometidos a ICP primaria, el prasugrel y el ticagrelor demostraron una eficacia global comparable con respecto al criterio final compuesto primario.
  • El uso de ticagrelor se asoció con un mayor riesgo de infarto de miocardio recurrente.
  • La elección entre ticagrelor y prasugrel en este contexto requiere una cuidadosa consideración de los factores de riesgo individuales del paciente.