Alp Aytekin1, Gjin Ndrepepa1, Franz-Josef Neumann2, Maurizio Menichelli3, Katharina Mayer1, Jochen Wöhrle4, Isabell Bernlochner5,6, Shqipdona Lahu1, Gert Richardt7, Bernhard Witzenbichler8, Dirk Sibbing9, Salvatore Cassese1, Dominick J Angiolillo10, Christian Valina2, Sebastian Kufner1, Christoph Liebetrau11, Christian W Hamm11,12, Erion Xhepa1, Alexander Hapfelmeier13, Hendrik B Sager1,6, Isabel Wustrow5, Michael Joner1,6, Dietmar Trenk2, Massimiliano Fusaro1, Karl-Ludwig Laugwitz5,6, Heribert Schunkert1,6, Stefanie Schüpke1,6, Adnan Kastrati6. 1. Deutsches Herzzentrum München, Cardiology and Technische Universität München, Munich, Germany (A.A., G.N., K.M., S.L., S.C., S.K., E.X., H.B.S., M.J., M.F., H.S., S.S., A.K). 2. Department of Cardiology and Angiology II, University Heart Center Freiburg·Bad Krozingen, Germany (F.J.N., C.V., D.T.). 3. Ospedale Fabrizio Spaziani, Cardiology, Frosinone, Italy (M.M.). 4. Department of Cardiology, Medical Campus Lake Constance, Friedrichshafen, Germany (J.W.). 5. Medizinische Klinik und Poliklinik Innere Medizin I (Kardiologie, Angiologie, Pneumologie), Klinikum Rechts der Isar, Munich, Germany (I.B., I.W., K.L.L). 6. German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (I.B., D.S., K.L.L., H.B.S., M.J., H.S., S.S., A.K.). 7. Heart Center Bad Segeberg, Germany (G.R.). 8. Helios Amper-Klinikum Dachau, Cardiology & Pneumology, Germany (B.W.). 9. Klinik der Universität München, Ludwig-Maximilians-University, Cardiology, Munich, Germany (D.S.). 10. Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.). 11. Heart Center, Campus Kerckhoff of Justus-Liebig-University, Giessen, Germany (C.L.,C.W.H.). 12. German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany (C.W.H.). 13. Technical University of Munich, School of Medicine, Institute of General Practice and Health Services Research, Germany (A.H.).
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.
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.
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