No randomized head-to-head study comparing the efficacy and safety of ticagrelor and prasugrel has been carried out in the last 7 years since these newer P2Y12 inhibitors first showed a higher efficacy relative to clopidogrel.

This study was designed to compare the efficacy and safety of prasugrel and ticagrelor in patients with acute myocardial infarction treated with primary angioplasty.

A total of 1230 patients were enrolled and randomized to receive one drug or the other; treatment begun before the procedure.

Nearly 4% of infarctions were in cardiogenic shock and 5.2% required mechanical ventilation.

The primary endpoint was defined as death, re-infarction, urgent revascularization, stroke, major bleeding or extended hospitalization (beyond 7 days).

This analysis presents data from the first 30 days, but the total follow-up planned is 1 year and will be completed by 2017.

The study was prematurely terminated due to the wide similarity between these drugs. The primary endpoint was 4% for prasugrel vs. 4.1% for ticagrelor (odds ratio [OR]: 0.98; 95% confidence interval [CI]: 0.55 to 1.73; p = 0.939). No significant difference was observed in any of the different components of the primary endpoint.

At 30 days, the secondary endpoint composed of cardiovascular death, non-fatal infarction, or stroke did not show any significant difference between these drugs (prasugrel 2.7% vs. ticagrelor 2.5%; OR: 1.06; p = 0.864).

Conclusion

This head-to-head comparison of prasugrel and ticagrelor did not show any difference between these drugs regarding efficacy or safety in patients with acute myocardial infarction undergoing primary angioplasty.

The rates of major events were similar, although with broad confidence intervals around the estimates. In consequence, these observations must be confirmed in a larger study.

Original title: Prasugrel Versus Ticagrelor in Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention. Multicenter Randomized PRAGUE-18 Study.

Reference: Motovska Z et al. Circulation. 2016 Nov 22;134(21):1603-1612.

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