TY - JOUR
T1 - Prior Myocardial Infarction and Treatment Effect of Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndromes-A Post-hoc Analysis of the ISAR-REACT 5 Trial
AU - Lahu, Shqipdona
AU - Scalamogna, Maria
AU - Ndrepepa, Gjin
AU - Menichelli, Maurizio
AU - Valina, Christian
AU - Hemetsberger, Rayyan
AU - Witzenbichler, Bernhard
AU - Bernlochner, Isabell
AU - Joner, Michael
AU - Xhepa, Erion
AU - Hapfelmeier, Alexander
AU - Kufner, Sebastian
AU - Sager, Hendrik B.
AU - Mayer, Katharina
AU - Kessler, Thorsten
AU - Laugwitz, Karl Ludwig
AU - Richardt, Gert
AU - Schunkert, Heribert
AU - Neumann, Franz Josef
AU - Kastrati, Adnan
AU - Cassese, Salvatore
N1 - Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2022/12/20
Y1 - 2022/12/20
N2 - BACKGROUND: The efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndrome and prior myo-cardial infarction (MI) remain unstudied. We aimed to assess the treatment effect of ticagrelor versus prasugrel according to prior MI status in patients with ACS. METHODS AND RESULTS: Patients with acute coronary syndrome planned for an invasive strategy and randomized to ticagre-lor or prasugrel in the ISAR-REACT (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment) 5 trial were included. The primary end point was the composite of 1-year all-cause death, MI, or stroke; the secondary safety end point was the composite of 1-year Bleeding Academic Research Consortium type 3 to 5 bleeding. The study included 4015 patients (prior MI=631 patients; no prior MI=3384 patients). As compared with patients without prior MI, the primary end point occurred more frequently in patients with prior MI (12.6% versus 7.2%; hazard ratio [HR], 1.78 [95% CI, 1.38– 2.29]); the secondary safety end point appears to differ little between patients with and without prior MI (5.8% versus 5.7%, respectively; HR, 1.02 [95% CI, 0.71–1.45]). With regard to the primary end point, ticagrelor versus prasugrel was associated with an HR of 1.62 (95% CI, 1.03– 2.55) in patients with prior MI and an HR of 1.28 (95% CI, 0.99–1.65) in patients without prior MI (Pint =0.37). With regard to the secondary safety end point, ticagrelor versus prasugrel was associated with an HR of 1.28 (95% CI, 0.56– 2.91) in patients with prior MI and an HR of 1.13 (95% CI, 0.82–1.55) in patients without prior MI (Pint =0.79). CONCLUSIONS: Patients with acute coronary syndrome and prior MI are at higher risk for recurrent ischemic but not bleeding events. Prasugrel is superior to ticagrelor in reducing the risk of ischemic events without a tradeoff in bleeding regardless of prior MI status. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01944800.
AB - BACKGROUND: The efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndrome and prior myo-cardial infarction (MI) remain unstudied. We aimed to assess the treatment effect of ticagrelor versus prasugrel according to prior MI status in patients with ACS. METHODS AND RESULTS: Patients with acute coronary syndrome planned for an invasive strategy and randomized to ticagre-lor or prasugrel in the ISAR-REACT (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment) 5 trial were included. The primary end point was the composite of 1-year all-cause death, MI, or stroke; the secondary safety end point was the composite of 1-year Bleeding Academic Research Consortium type 3 to 5 bleeding. The study included 4015 patients (prior MI=631 patients; no prior MI=3384 patients). As compared with patients without prior MI, the primary end point occurred more frequently in patients with prior MI (12.6% versus 7.2%; hazard ratio [HR], 1.78 [95% CI, 1.38– 2.29]); the secondary safety end point appears to differ little between patients with and without prior MI (5.8% versus 5.7%, respectively; HR, 1.02 [95% CI, 0.71–1.45]). With regard to the primary end point, ticagrelor versus prasugrel was associated with an HR of 1.62 (95% CI, 1.03– 2.55) in patients with prior MI and an HR of 1.28 (95% CI, 0.99–1.65) in patients without prior MI (Pint =0.37). With regard to the secondary safety end point, ticagrelor versus prasugrel was associated with an HR of 1.28 (95% CI, 0.56– 2.91) in patients with prior MI and an HR of 1.13 (95% CI, 0.82–1.55) in patients without prior MI (Pint =0.79). CONCLUSIONS: Patients with acute coronary syndrome and prior MI are at higher risk for recurrent ischemic but not bleeding events. Prasugrel is superior to ticagrelor in reducing the risk of ischemic events without a tradeoff in bleeding regardless of prior MI status. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01944800.
KW - acute coronary syndrome
KW - percutaneous coronary intervention
KW - prasugrel
KW - prior myocardial infarction
KW - ticagrelor
UR - http://www.scopus.com/inward/record.url?scp=85144511072&partnerID=8YFLogxK
U2 - 10.1161/JAHA.122.027257
DO - 10.1161/JAHA.122.027257
M3 - Article
C2 - 36515247
AN - SCOPUS:85144511072
SN - 2047-9980
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 24
M1 - e027257
ER -