In patients undergoing ST elevation acute myocardial infarction (STEMI) receiving primary PCI, no significative differences between prasugrel and ticagrelor were found. However, the latter was associated to a significantly higher number of repeat MI when considered separately.
Few studies have compared the efficacy and safety of the two most potent oral P2Y12 receptor inhibitors in STEMI patients undergoing PCI. There is a large body of evidence resulting from studies comparing each of them separately vs clopidogrel, but not against each other.
This analysis prespecified in the ISAR REACT-5 protocol included 1653 STEMI patients randomized to ticagrelor or prasugrel.
The primary end point was a composite of death, MI and stroke at one year after randomization. The secondary end point was the incidence of major bleeding (BARC 3 to 5) for the same period.
The combined end point occurred in 10.1% of patients in the ticagrelor group vs 7.9% of prasugrel patients (p=0.10). When considering its separate components, they observed similar results in death (4.9% vs 4.7%, p=0.83) and stroke (1.3% vs 1%, p=0.46), as well as definite thrombosis (1.8% vs 1%, p=0.15).
Read also: TCT 2020 | Ticagrelor Monotherapy After ST-Segment Elevation Infarction.
The difference in new events rate was significant, prasugrel winning with 2.8% against 5.3% of ticagrelor (p=0.010). This difference tends to disappear with all events combined.
Major bleeding rates according to the Bleeding Academic Research Consortium (BARC 3 to 5) were practically identical with 6.1% for ticagrelor and 5.1% for prasugrel (p=0.36).
Conclusion
In STEMI patients undergoing primary PCI there were no differences in the combined primary end point between ticagrelor and prasugrel. When considering MI separately, prasugrel has an advantage.
Original Title: Ticagrelor or Prasugrel in Patients with ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.
Reference: Alp Aytekin et al. Circulation. 2020, Online ahead of print. doi: 10.1161/CIRCULATIONAHA.120.050244.
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