Ticagrelor or prasugrel in patients with acute coronary syndrome with off-hour versus on-hour presentation: a subgroup analysis of the ISAR-REACT 5 trial

Michael Behnes, Shqipdona Lahu, Gjin Ndrepepa, Maurizio Menichelli, Katharina Mayer, Jochen Wöhrle, Isabell Bernlochner, Senta Gewalt, Bernhard Witzenbichler, Willibald Hochholzer, Dirk Sibbing, Salvatore Cassese, Dominick J. Angiolillo, Rayyan Hemetsberger, Christian Valina, Arne Müller, Sebastian Kufner, Christian W. Hamm, Erion Xhepa, Alexander HapfelmeierHendrik B. Sager, Michael Joner, Massimiliano Fusaro, Gert Richardt, Karl Ludwig Laugwitz, Franz Josef Neumann, Heribert Schunkert, Stefanie Schüpke, Adnan Kastrati, Ibrahim Akin

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objectives: To assess the efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndrome (ACS) presenting during off- and on-hours. Background: The efficacy and safety of ticagrelor versus prasugrel in patients with ACS according to time of hospital presentation remain unknown. Methods: This post hoc analysis of the ISAR-REACT 5 trial included 1565 patients with ACS presenting off-hours and 2453 patients presenting on-hours, randomized to ticagrelor or prasugrel. The primary endpoint was a composite of death, myocardial infarction, or stroke; the safety endpoint was Bleeding Academic Research Consortium (BARC) type 3–5 bleeding, both at 12 months. Results: The primary endpoint occurred in 80 patients (10.4%) in the ticagrelor group and 57 patients (7.3%) in the prasugrel group in patients presenting off-hours (hazard ratio [HR] = 1.45; 95% confidence interval [CI] 1.03–2.03; P = 0.033), and 104 patients (8.5%) in the ticagrelor group and 80 patients (6.7%) in the prasugrel group in patients presenting on-hours (HR = 1.29 [0.97–1.73]; P = 0.085), without significant treatment arm-by-presentation time interaction (Pint = 0.62). BARC type 3 to 5 bleeding occurred in 35 patients (5.1%) in the ticagrelor group and 37 patients (5.3%) in the prasugrel group (P = 0.84) in patients presenting off-hours, and 60 patients (5.9%) in the ticagrelor group and 43 patients (4.6%) in the prasugrel group in patients presenting on-hours (P = 0.17). Conclusions: In patients with ACS planned to undergo an invasive treatment strategy, time of presentation (off-hours vs. on-hours) does not interact significantly with the relative efficacy and safety of ticagrelor vs. prasugrel. Clinical trial registration.: NCT01944800. Graphical abstract: [Figure not available: see fulltext.].

Original languageEnglish
Pages (from-to)518-528
Number of pages11
JournalClinical research in cardiology : official journal of the German Cardiac Society
Volume112
Issue number4
DOIs
StatePublished - Apr 2023

Keywords

  • Acute coronary syndromes
  • Off-hour presentation
  • Percutaneous coronary intervention
  • Prasugrel
  • Ticagrelor

Fingerprint

Dive into the research topics of 'Ticagrelor or prasugrel in patients with acute coronary syndrome with off-hour versus on-hour presentation: a subgroup analysis of the ISAR-REACT 5 trial'. Together they form a unique fingerprint.

Cite this