The choice of prasugrel or ticagrelor for patients with acute myocardial infarction undergoing primary angioplasty makes no difference, at least in the short term.
This study was terminated prematurely and thus lost statistical power, which means that any interpretation of the lack of difference between the two antiplatelet drugs must take into account such context.
This presentation with simultaneous publication in Circulation showed no differences in the combined endpoint at 7 and 30 days. Based on these results, it could be said that both drugs are equivalent or at least very similar.
Both drugs maintain equal footing in the guidelines, although there are recommendations against using prasugrel in patients with a history of stroke or transient ischemic attack. As a result, this seems to be a good moment to consider the realization of a randomized head-to-head trial with enough statistical power.
The target enrollment was 2500 patients, but the trial was stopped prematurely after only 1230 patients were enrolled. The primary endpoint (which combined death, reinfarction, urgent revascularization, stroke, major bleeding, or prolonged hospitalization) turned out to be very similar between the prasugrel and ticagrelor groups (4.0% vs. 4.1%; odds ratio [OR]: 0.98; 95% confidence interval [CI]: 0.55-1.73).
Original title: Prasugrel versus ticagrelor in patients with acute myocardial infarction treated with primary percutaneous coronary intervention: multicenter randomized PRAGUE-18 study.
Presenter: Petr Widimsky.
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