Key result
Prasugrel and ticagrelor showed no significant difference in the 1-year risk of the composite of all-cause death, non-fatal myocardial infarction, or stroke in PCI-treated ACS/AMI patients (RR 0.921).
Why the study?
Guidelines recommend ticagrelor or prasugrel over clopidogrel for ACS, but comparative effectiveness and safety between prasugrel and ticagrelor in PCI-treated ACS/AMI needed clarification.
Does prasugrel compared to ticagrelor reduce the composite of 1-year all-cause death, non-fatal MI, or stroke in patients with ACS/AMI undergoing PCI?
Meta-Analysis (n=10,479)
Does prasugrel compared to ticagrelor reduce the composite of 1-year all-cause death, non-fatal MI, or stroke in patients with ACS/AMI undergoing PCI?
Relative Risk: 0.921 (95% CI 0.719–1.181)
p-value: p=0.518
Prasugrel and ticagrelor demonstrate similar efficacy and safety profiles at 1 year in patients with ACS/AMI undergoing PCI, suggesting either agent can be chosen based on patient compliance and cost.
Prasugrel and ticagrelor show comparable 1-year efficacy and safety post-PCI; confirms equivalence in guidelines while leaving open subgroup-specific questions.
Introduction: As per international guidelines the P2Y12 receptor inhibitor, ticagrelor or prasugrel is recommended over clopidogrel for patients with acute coronary syndrome (ACS). Aims: To determine the effectiveness and safety of Prasugrel versus ticagrelor in patients with ACS/AMI (acute myocardial infarction) who underwent percutaneous coronary intervention (PCI) through meta-analysis of clinical trials. Methods: We performed a meta-analysis of randomized and non-randomized trials [with search results up to April 2023 in the following databases: PubMed (MEDLINE) and Google Scholar comparing prasugrel and ticagrelor in PCI-treated acute ACS/ AMI patients for the following: Composite of 1-year all-cause death, non-fatal MI, or stroke; Composite of 1-year cardiovascular death, non-fatal MI, or stroke; and individual parameters (all-cause death, cardiovascular death, non-fatal MI and stroke) and major bleeding as Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding (more severe bleeding) at 1-year. 4 studies met the metanalysis inclusion criteria. It was conducted on the data of a total of 10479 patients (5079 in the prasugrel group and 5400 ticagrelor group). Results: Prasugrel and ticagrelor have insignificant differences for the pooled relative risks of the following: composite of 1-year all-cause death, non-fatal myocardial infarction (MI), or stroke 0.921 (95% CI, 0.719 to 1.181; p =0.518); composite of 1-year cardiovascular death, non-fatal MI, or stroke 0.830 (95% CI, 0.598 to 1.152; p =0.265); BARC type 3 to 5 bleeding (more severe bleeding) at 1-year was 0.988 (95% CI, 0.774 to 1.262; p =0.924); individual parameters (all-cause death, cardiovascular death, non-fatal myocardial infarction (MI) and stroke). There was either inconsistency/heterogeneity and minimal or no inconsistency/ heterogeneity for different parameters in the data. There was no publication bias for all trials. Conclusion: Prasugrel and ticagrelor have similar effects for their relative risks of the following; composite of 1-year all-cause death, non-fatal MI, or stroke; composite of 1-year cardiovascular death, non-fatal MI, or stroke; and individual parameters and BARC type 3 to 5 bleeding at 1 year in patients with ACS/AMI undergoing PCI.
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Karthikeyan et al. (2023) conducted a meta-analysis in Acute Coronary Syndrome (ACS) / Acute Myocardial Infarction (AMI) treated with PCI (n=10,479). Prasugrel vs. Ticagrelor was evaluated on Composite of 1-year all-cause death, non-fatal myocardial infarction, or stroke (RR 0.921, 95% CI 0.719 to 1.181, p=0.518). Prasugrel and ticagrelor showed no significant difference in the 1-year risk of the composite of all-cause death, non-fatal myocardial infarction, or stroke in PCI-treated ACS/AMI patients (RR 0.921).
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