In MI, prasugrel and ticagrelor confer similar safety, efficacy after PCI
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Prasugrel and ticagrelor had similar safety and efficacy among patients with MI receiving PCI, according to results published in Heart.
“Dual antiplatelet therapy, with aspirin and a P2Y12 receptor inhibitor, is the main antithrombotic treatment in patients with ACS,” Dimitrios Venetsanos, MD, PhD, interventional cardiologist and senior consultant at Karolinska Institutet Solna, Stockholm, and colleagues wrote. “Ticagrelor and prasugrel have proven superior to clopidogrel in reducing the risk of major adverse cardiac events, but at the expense of a higher bleeding rate.”
In a retrospective study, researchers analyzed 37,990 patients from the SWEDEHEART registry with MI who underwent PCI to compare the clinical outcomes of prasugrel (Effient, Daiichi Sankyo/Eli Lilly) and ticagrelor (Brilinta, AstraZeneca). Outcomes of interest included 1-year MACCE (defined as death/MI/stroke), death, MI, stroke and major bleeding. Researchers utilized multivariable adjustment, inverse probability of treatment weighting and propensity-score matching to adjust for confounders.
The researchers found no differences between prasugrel and ticagrelor in risk for MACCE (6.1% for both groups; adjusted HR = 1.03; 95% CI, 0.86-1.24). Further, researchers found no significant difference in the risk for all-cause mortality (cumulative rate, 2.3% vs. 2.9%, respectively; aHR = 0.89; 95% CI, 0.67-1.2), recurrent MI (cumulative rate, 4.1% vs. 3.2%, respectively; aHR= 1.26; 95% CI, 0.98-1.58) or stroke (cumulative rate, 0.9% vs. 1.1%, respectively; aHR = 0.94; 95% CI, 0.58-1.53) as well as no significant difference in major bleeding risk (2.5% vs. 3.2%; aHR= 0.92; 95% CI, 0.69-1.22).
“In this real-world observational study, we found no significant difference in a composite of death, MI or stroke at 1-year follow-up in patients with MI treated with PCI and discharged with prasugrel or ticagrelor. Moreover, there were no significant differences in the individual components of the composite outcome or bleeding complications,” Venetsanos and colleagues wrote. “Adjusted analyses with inverse probability of treatment weighting and propensity-score matching confirmed our results.”
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