Ticagrelor or Prasugrel in Patients with ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Alp Aytekin, Gjin Ndrepepa, Franz Josef Neumann, Maurizio Menichelli, Katharina Mayer, Jochen Wöhrle, Isabell Bernlochner, Shqipdona Lahu, Gert Richardt, Bernhard Witzenbichler, Dirk Sibbing, Salvatore Cassese, Dominick J. Angiolillo, Christian Valina, Sebastian Kufner, Christoph Liebetrau, Christian W. Hamm, Erion Xhepa, Alexander Hapfelmeier, Hendrik B. SagerIsabel Wustrow, Michael Joner, Dietmar Trenk, Massimiliano Fusaro, Karl Ludwig Laugwitz, Heribert Schunkert, Stefanie Schüpke, Adnan Kastrati

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31 Scopus citations

Abstract

Background: Data on the comparative efficacy and safety of ticagrelor versus prasugrel in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention are limited. We assessed the efficacy and safety of ticagrelor versus prasugrel in a head-to-head comparison in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods: In this prespecified subgroup analysis, we included 1653 patients with ST-segment-elevation myocardial infarction randomized to receive ticagrelor or prasugrel in the setting of the ISAR REACT-5 trial (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 5). The primary end point was the incidence of death, myocardial infarction, or stroke at 1 year after randomization. The secondary end point was the incidence of bleeding defined as BARC (Bleeding Academic Research Consortium) type 3 to 5 bleeding at 1 year after randomization. Results: The primary end point occurred in 83 patients (10.1%) in the ticagrelor group and in 64 patients (7.9%) in the prasugrel group (hazard ratio, 1.31 [95% CI, 0.95-1.82]; P=0.10). One-year incidence of all-cause death (4.9% versus 4.7%; P=0.83), stroke (1.3% versus 1.0%; P=0.46), and definite stent thrombosis (1.8% versus 1.0%; P=0.15) did not differ significantly in patients assigned to ticagrelor or prasugrel. One-year incidence of myocardial infarction (5.3% versus 2.8%; hazard ratio, 1.95 [95% CI, 1.18-3.23]; P=0.010) was higher with ticagrelor than with prasugrel. BARC type 3 to 5 bleeding occurred in 46 patients (6.1%) in the ticagrelor group and in 39 patients (5.1%) in the prasugrel group (hazard ratio, 1.22 [95% CI, 0.80-1.87]; P=0.36). Conclusions: In patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, there was no significant difference in the primary end point between prasugrel and ticagrelor. Ticagrelor was associated with a significant increase in the risk for recurrent myocardial infarction. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01944800.

Original languageEnglish
Pages (from-to)2329-2337
Number of pages9
JournalCirculation
Volume142
Issue number24
DOIs
StatePublished - 15 Dec 2020

Keywords

  • P2Y12 receptor antagonists
  • ST elevation myocardial infarction
  • hemorrhage
  • mortality
  • percutaneous coronary intervention
  • prasugrel hydrochloride
  • thrombosis
  • ticagrelor

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