Prasugrel versus ticagrelor in patients with myocardial infarction undergoing percutaneous coronary intervention.

Abstract

OBJECTIVE:

The comparative efficacy and safety of prasugrel and ticagrelor in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) remain unclear. We aimed to investigate the association of treatment with clinical outcomes.

METHODS:

In the SWEDEHEART (Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies) registry, all patients with MI treated with PCI and discharged on prasugrel or ticagrelor from 2010 to 2016 were included. Outcomes were 1-year major adverse cardiac and cerebrovascular events (MACCE, death, MI or stroke), individual components and bleeding. Multivariable adjustment, inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to adjust for confounders.

RESULTS:

We included 37 990 patients, 2073 in the prasugrel group and 35 917 in the ticagrelor group. Patients in the prasugrel group were younger, more often admitted with ST elevation MI and more likely to have diabetes. Six to twelve months after discharge, 20% of patients in each group discontinued the P2Y12 receptor inhibitor they received at discharge. The risk for MACCE did not significantly differ between prasugrel-treated and ticagrelor-treated patients (adjusted HR 1.03, 95% CI 0.86 to 1.24). We found no significant difference in the adjusted risk for death, recurrent MI or stroke alone between the two treatments. There was no significant difference in the risk for bleeding with prasugrel versus ticagrelor (2.5% vs 3.2%, adjusted HR 0.92, 95% CI 0.69 to 1.22). IPTW and PSM analyses confirmed the results.

CONCLUSION:

In patients with MI treated with PCI, prasugrel and ticagrelor were associated with similar efficacy and safety during 1-year follow-up.

• Authors: Dimitrios Venetsanos, Erik Träff, David Erlinge, Emil Hagström, Johan Nilsson, Liyew Desta, Bertil Lindahl, Linda Mellbin, Elmir Omerovic, Karolina Elisabeth Szummer, Sammy Zwackman, Tomas Jernberg, Joakim Alfredsson
• Journal: Heart (British Cardiac Society) (Heart) Vol. 107 Issue 14 Pg. 1145-1151 (07 2021) ISSN: 1468-201X [Electronic] England
• PMID: 33712510 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Purinergic P2Y Receptor Antagonists
• Clopidogrel
• Prasugrel Hydrochloride
• Ticagrelor

Topics

• Aged
• Clopidogrel (administration & dosage, adverse effects)
• Female
• Hemorrhage (chemically induced, diagnosis)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (drug therapy, epidemiology, prevention & control, surgery)
• Patient Discharge (statistics & numerical data)
• Percutaneous Coronary Intervention (methods, statistics & numerical data)
• Postoperative Complications (diagnosis, mortality, prevention & control)
• Prasugrel Hydrochloride (administration & dosage, adverse effects)
• Purinergic P2Y Receptor Antagonists (administration & dosage, adverse effects)
• Retrospective Studies
• Stroke (etiology, mortality, prevention & control)
• Sweden (epidemiology)
• Ticagrelor (administration & dosage, adverse effects)
• Treatment Outcome