Germany: The use of ticagrelor versus prasugrel in STEMI patients undergoing primary PCI did not lead to significant differences in incidence of death, stroke or myocardial infarction (MI), a recent study in the journal Circulation has suggested. However, ticagrelor was associated with a significant increase in MI risk.
There is a limited data on the comparative efficacy and safety of ticagrelor versus prasugrel in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Alp Aytekin, Cardiology and Technische Universität München, both in Munich, Germany, and colleagues assessed the safety and efficacy of ticagrelor versus prasugrel in a head-to-head comparison in STEMI patients undergoing primary PCI.
The pre-specified subgroup analysis included 1653 patients with STEMI. They were randomized to receive ticagrelor or prasugrel in the setting of the ISAR REACT-5 trial.
The primary endpoint was the incidence of death, myocardial infarction or stroke at 1 year after randomization. The secondary endpoint was the incidence of bleeding defined as Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding at 1 year after randomization.
Key findings of the study include:
The primary endpoint occurred in 10.1% in the ticagrelor group and in 7.9% in the prasugrel group (hazard ratio [HR]=1.31).
One-year incidence of all-cause death (4.9% vs. 4.7%), stroke (1.3% vs. 1.0%) and definite stent thrombosis (1.8% vs. 1.0%) did not differ significantly in patients assigned to ticagrelor or prasugrel.
One-year incidence of myocardial infarction (5.3% vs. 2.8%; HR=1.95) was higher with ticagrelor than with prasugrel.
BARC type 3 to 5 bleeding occurred in 6.1% patients in the ticagrelor group and in 5.1% patients in the prasugrel group (HR=1.22).
"Our results showed that in patients with STEMI undergoing primary PCI, there was no significant difference in the primary endpoint between prasugrel and ticagrelor. Ticagrelor was associated with a significant increase in the risk for recurrent myocardial infarction," concluded the authors.
The study, "Ticagrelor or Prasugrel in Patients with ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention," is published in the journal Circulation.
DOI: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.050244