Key result
Ticagrelor shows no benefit over prasugrel for 1-year death, MI, or stroke.
Why the study?
Data on the comparative efficacy and safety of ticagrelor versus prasugrel in patients with STEMI undergoing primary PCI are limited.
Does ticagrelor compared to prasugrel reduce the composite of death, myocardial infarction, or stroke in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention?
RCT (n=1,653)
randomized
Does ticagrelor compared to prasugrel reduce the composite of death, myocardial infarction, or stroke in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention?
Hazard Ratio: 1.31 (95% CI 0.95–1.82)
Absolute Event Rate: 10.1% vs 7.9%
p-value: p=0.10
In patients with STEMI undergoing primary PCI, ticagrelor and prasugrel showed no significant difference in the primary composite endpoint of death, MI, or stroke, though ticagrelor was associated with a higher risk of recurrent MI.
Supports either agent in STEMI primary PCI; extends randomized comparisons of comparable efficacy to this population.
Background: Data on the comparative efficacy and safety of ticagrelor versus prasugrel in patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention are limited. We assessed the efficacy and safety of ticagrelor versus prasugrel in a head-to-head comparison in patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods: In this prespecified subgroup analysis, we included 1653 patients with ST-segment–elevation myocardial infarction randomized to receive ticagrelor or prasugrel in the setting of the ISAR REACT-5 trial (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 5). The primary end point was the incidence of death, myocardial infarction, or stroke at 1 year after randomization. The secondary end point was the incidence of bleeding defined as BARC (Bleeding Academic Research Consortium) type 3 to 5 bleeding at 1 year after randomization. Results: The primary end point occurred in 83 patients (10.1%) in the ticagrelor group and in 64 patients (7.9%) in the prasugrel group (hazard ratio, 1.31 [95% CI, 0.95–1.82]; P =0.10). One-year incidence of all-cause death (4.9% versus 4.7%; P =0.83), stroke (1.3% versus 1.0%; P =0.46), and definite stent thrombosis (1.8% versus 1.0%; P =0.15) did not differ significantly in patients assigned to ticagrelor or prasugrel. One-year incidence of myocardial infarction (5.3% versus 2.8%; hazard ratio, 1.95 [95% CI, 1.18–3.23]; P =0.010) was higher with ticagrelor than with prasugrel. BARC type 3 to 5 bleeding occurred in 46 patients (6.1%) in the ticagrelor group and in 39 patients (5.1%) in the prasugrel group (hazard ratio, 1.22 [95% CI, 0.80–1.87]; P =0.36). Conclusions: In patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention, there was no significant difference in the primary end point between prasugrel and ticagrelor. Ticagrelor was associated with a significant increase in the risk for recurrent myocardial infarction. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01944800.
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Aytekin et al. (2020) conducted an RCT in ST-segment-elevation myocardial infarction (n=1,653). Ticagrelor vs. Prasugrel was evaluated on incidence of death, myocardial infarction, or stroke at 1 year after randomization (HR 1.31, 95% CI 0.95-1.82, p=0.10). Ticagrelor did not significantly differ from prasugrel for the 1-year incidence of death, myocardial infarction, or stroke (10.1% vs 7.9%; HR 1.31; 95% CI 0.95-1.82; P=0.10).
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