Ticagrelor or Prasugrel in Patients With Acute Coronary Syndrome in Relation to Estimated Glomerular Filtration Rate

Jochen Wöhrle, Julia Seeger, Shqipdona Lahu, Katharina Mayer, Isabell Bernlochner, Senta Gewalt, Maurizio Menichelli, Bernhard Witzenbichler, Willibald Hochholzer, Dirk Sibbing, Salvatore Cassese, Dominick J. Angiolillo, Rayyan Hemetsberger, Christian Valina, Sebastian Kufner, Erion Xhepa, Alexander Hapfelmeier, Hendrik B. Sager, Michael Joner, Gert RichardtKarl Ludwig Laugwitz, Franz Josef Neumann, Heribert Schunkert, Stefanie Schüpke, Adnan Kastrati, Gjin Ndrepepa

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Objectives: The aim of this study was to assess the safety and efficacy of ticagrelor versus prasugrel for patients with acute coronary syndrome (ACS) according to their estimated glomerular filtration rates (eGFRs). Background: The outcomes of ticagrelor versus prasugrel in patients with ACS according to eGFR have not been defined. Methods: Patients (n = 4,012) were categorized into 3 groups: low eGFR (<60 mL/min/1.73 m2), intermediate eGFR (≥60 and <90 mL/min/1.73 m2), and high eGFR (≥90 mL/min/1.73 m2). The primary endpoint was a composite of all-cause death, myocardial infarction, and stroke; the secondary safety endpoint was Bleeding Academic Research Consortium types 3 to 5 bleeding, both at 1 year. Results: Patients with low eGFRs had a higher risk for the primary endpoint compared with patients with intermediate eGFRs (adjusted HR: 1.89; 95% CI: 1.46-2.46]) and those with high eGFRs (adjusted HR: 2.33; 95% CI: 1.57-3.46). A risk excess for low eGFR was also observed for bleeding (adjusted HR: 1.55 [95% CI: 1.12-2.13] vs intermediate eGFR; adjusted HR: 1.59 [95% CI: 1.01-2.50] vs high eGFR). However, eGFR did not affect the relative efficacy and safety of ticagrelor versus prasugrel. In patients with low eGFR, the primary endpoint occurred in 20.5% with ticagrelor and in 14.7% with prasugrel (HR: 1.47; 95% CI: 1.04-2.08; P = 0.029); there was no significant difference in bleeding. Conclusions: These results show that among patients with ACS, reduction of eGFR is associated with increased risk for ischemic and bleeding events but has no significant impact on the relative efficacy and safety of ticagrelor versus prasugrel.

Original languageEnglish
Pages (from-to)1857-1866
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume14
Issue number17
DOIs
StatePublished - 13 Sep 2021

Keywords

  • acute coronary syndrome
  • glomerular filtration rate
  • percutaneous coronary intervention
  • prasugrel
  • ticagrelor

Fingerprint

Dive into the research topics of 'Ticagrelor or Prasugrel in Patients With Acute Coronary Syndrome in Relation to Estimated Glomerular Filtration Rate'. Together they form a unique fingerprint.

Cite this