Key result
Ticagrelor showed no significant difference compared to prasugrel for net adverse cardiac events in men (HR 0.94; 95% CI 0.69-1.29) or women (HR 1.17; 95% CI 0.63-2.20) with ACS undergoing PCI.
Why the study?
Potent P2Y12 inhibitors are recommended in ACS patients undergoing PCI, but differences in efficacy and safety between ticagrelor and prasugrel required sex-specific evaluation in a real-world setting.
Does ticagrelor reduce net adverse cardiac events compared to prasugrel in male and female patients with acute coronary syndrome undergoing PCI?
Cohort (n=4,424)
Yes
Does ticagrelor reduce net adverse cardiac events compared to prasugrel in male and female patients with acute coronary syndrome undergoing PCI?
Effect estimate: HR 0.94 (men), HR 1.17 (women) (95% CI 0.69-1.29 (men), 0.63-2.20 (women))
p-value: p=0.71 (men), 0.62 (women)
Ticagrelor and prasugrel demonstrate comparable efficacy and safety in real-world ACS patients undergoing PCI, with no significant differences observed between men and women.
Comparable NACE rates with ticagrelor or prasugrel across sexes; leaves open need for randomized confirmation in ACS-PCI.
BACKGROUND: The use of potent P2Y12 inhibitors (ticagrelor & prasugrel) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary interventions (PCI) is a class I recommendation. We performed a sex-specific analysis comparing the difference in efficacy and safety outcomes between ticagrelor and prasugrel in a real-world ACS population. METHODS: Data from the multicenter REgistry of New Antiplatelets in patients with Myocardial Infarction (RENAMI) for 4424 ACS patients who underwent PCI and were treated with ticagrelor or prasugrel between 2012 to 2016 were analyzed. Mean follow-up was 17±9 months. RESULTS: After propensity score matching, there was no significant difference in the occurrence of primary endpoint of net adverse cardiac events between ticagrelor and prasugrel in men (HR: 0.94; 95% CI: 0.69-1.29; P=0.71), or women (HR: 1.17; 95% CI: 0.63-2.20; P=0.62; P interaction [sex] = 0.40). Similarly, no differences were found in the occurrence of any of the secondary endpoints (MACE, all cause death, re-infarction, stent thrombosis, BARC major bleeding and BARC any bleeding) between the two P2Y12 groups between men and women. CONCLUSIONS: In this real-world ACS population, no relative difference in efficacy or safety outcomes were found between ticagrelor and prasugrel between sexes.
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Raisi et al. (2021) conducted a cohort in acute coronary syndrome (ACS) (n=4,424). Ticagrelor vs. Prasugrel was evaluated on net adverse cardiac events (HR 0.94 (men), HR 1.17 (women), 95% CI 0.69-1.29 (men), 0.63-2.20 (women), p=0.71 (men), 0.62 (women)). Ticagrelor showed no significant difference compared to prasugrel for net adverse cardiac events in men (HR 0.94; 95% CI 0.69-1.29) or women (HR 1.17; 95% CI 0.63-2.20) with ACS undergoing PCI.
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