TY - JOUR
T1 - Ticagrelor or Prasugrel in Patients With Acute Coronary Syndrome in Relation to Estimated Glomerular Filtration Rate
AU - Wöhrle, Jochen
AU - Seeger, Julia
AU - Lahu, Shqipdona
AU - Mayer, Katharina
AU - Bernlochner, Isabell
AU - Gewalt, Senta
AU - Menichelli, Maurizio
AU - Witzenbichler, Bernhard
AU - Hochholzer, Willibald
AU - Sibbing, Dirk
AU - Cassese, Salvatore
AU - Angiolillo, Dominick J.
AU - Hemetsberger, Rayyan
AU - Valina, Christian
AU - Kufner, Sebastian
AU - Xhepa, Erion
AU - Hapfelmeier, Alexander
AU - Sager, Hendrik B.
AU - Joner, Michael
AU - Richardt, Gert
AU - Laugwitz, Karl Ludwig
AU - Neumann, Franz Josef
AU - Schunkert, Heribert
AU - Schüpke, Stefanie
AU - Kastrati, Adnan
AU - Ndrepepa, Gjin
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/9/13
Y1 - 2021/9/13
N2 - 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.
AB - 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.
KW - acute coronary syndrome
KW - glomerular filtration rate
KW - percutaneous coronary intervention
KW - prasugrel
KW - ticagrelor
UR - http://www.scopus.com/inward/record.url?scp=85113513227&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2021.06.028
DO - 10.1016/j.jcin.2021.06.028
M3 - Article
C2 - 34446390
AN - SCOPUS:85113513227
SN - 1936-8798
VL - 14
SP - 1857
EP - 1866
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 17
ER -