1-year outcomes in PCI for STEMI similar in patients treated with ticagrelor vs. prasugrel
Click Here to Manage Email Alerts
Antiplatelet therapy with ticagrelor after primary PCI for STEMI may confer similar reductions in the composite endpoint of all-cause death, MI and stroke and major bleeding compared with prasugrel, researchers reported.
However, there was a significant risk reduction for the individual endpoint of MI among patients taking prasugrel (Effient, Daiichi Sankyo/Eli Lilly) compared with ticagrelor (Brilinta, AstraZeneca), according to a subanalysis of ISAR REACT-5 published in Circulation.
As Healio previously reported, patients with ACS, with or without STEMI, experienced a reduced risk for death, MI or stroke at 1 year with prasugrel compared with ticagrelor, with no greater risk for major bleeding.
For this subgroup analysis, investigators included 1,653 patients from the ISAR REACT-5 trial who experienced STEMI and were randomly assigned to ticagrelor or prasugrel after primary PCI. The primary endpoint was death, MI or stroke at 1 year and the secondary endpoint was Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding at 1 year.
The primary endpoint occurred in 10.1% of the ticagrelor group and 7.9% of the prasugrel group (HR = 1.31; 95% CI, 0.95-1.82).
Alp Aytekin, MD, from Deutsches Herzzentrum München, Cardiology and Technische Universität München, Munich, and colleagues found the 1-year incidence of all-cause death (HR = 1.05; 95% CI, 0.67-1.64), stroke (HR = 1.41; 95% CI, 0.57-3.5) and definite stent thrombosis (HR = 1.88; 95% CI, 0.8-4.44) were not significantly different between patients who received ticagrelor or prasugrel after PCI for STEMI.
At 1 year, MI occurred in 5.3% of the ticagrelor group compared with 2.8% of the prasugrel group (HR = 1.95; 95% CI, 1.18-3.23).
In addition, BARC type 3 to 5 bleeding occurred in 6.1% of the ticagrelor group and 5.1% of the prasugrel group (HR = 1.22; 95% CI, 0.8-1.87).
“Consistent with the results of the primary publication and other studies, our study showed that prasugrel and ticagrelor did not differ significantly with respect to the risk of bleeding,” the researchers wrote. “One possible explanation for the lack of excess risk of bleeding with prasugrel despite its stronger antithrombotic efficacy might be the adapted prasugrel dose regimen used in elderly and underweight patients.”
Collapse
Click Here to Manage Email Alerts