Prasugrel and ticagrelor demonstrated similar rates of cardiovascular death, MI, or stroke at 1 year in patients with acute MI (6.6% vs 5.7%; HR 1.167; 95% CI 0.742-1.835; p=0.503).
RCT (n=1,230)
Does prasugrel reduce the composite of cardiovascular death, MI, or stroke compared to ticagrelor in patients with acute myocardial infarction treated with primary percutaneous coronary intervention?
Prasugrel and ticagrelor demonstrated similar efficacy and safety at 1 year in patients with acute MI undergoing primary PCI, and an economically motivated switch to clopidogrel was not associated with increased ischemic risk.
Hazard Ratio: 1.167 (95% CI 0.742–1.835)
Absolute Event Rate: 6.6% vs 5.7%
p-value: p=0.503
BACKGROUND: inhibitors. OBJECTIVES: The 1-year follow-up of the PRAGUE-18 study focused on: 1) a comparison of efficacy and safety between prasugrel and ticagrelor; and 2) the risk of major ischemic events related to an economically motivated post-discharge switch to clopidogrel. METHODS: A total of 1,230 patients with acute myocardial infarction (MI) treated with primary percutaneous coronary intervention were randomized to prasugrel or ticagrelor with an intended treatment duration of 12 months. The combined endpoint was cardiovascular death, MI, or stroke at 1 year. Because patients had to cover the costs of study medication after hospital discharge, some patients decided to switch to clopidogrel. RESULTS: The endpoint occurred in 6.6% of prasugrel patients and in 5.7% of ticagrelor patients (hazard ratio: 1.167; 95% confidence interval: 0.742 to 1.835; p = 0.503). No significant differences were found in: cardiovascular death (3.3% vs. 3.0%; p = 0.769), MI (3.0% vs. 2.5%; p = 0.611), stroke (1.1% vs. 0.7%; p = 0.423), all-cause death (4.7% vs. 4.2%; p = 0.654), definite stent thrombosis (1.1% vs. 1.5%; p = 0.535), all bleeding (10.9% vs. 11.1%; p = 0.999), and TIMI (Thrombolysis In Myocardial Infarction) major bleeding (0.9% vs. 0.7%; p = 0.754). The percentage of patients who switched to clopidogrel for economic reasons was 34.1% (n = 216) for prasugrel and 44.4% (n = 265) for ticagrelor (p = 0.003). Patients who were economically motivated to switch to clopidogrel had (compared with patients who continued the study medications) a lower risk of major cardiovascular events; however, they also had lower ischemic risk. CONCLUSIONS: Prasugrel and ticagrelor are similarly effective during the first year after MI. Economically motivated early post-discharge switches to clopidogrel were not associated with an increased risk of ischemic events. (Comparison of Prasugrel and Ticagrelor in the Treatment of Acute Myocardial Infarction PRAGUE-18; NCT02808767).
Moťovská et al. (Tue,) conducted a rct in Acute myocardial infarction (MI) (n=1,230). Prasugrel vs. Ticagrelor was evaluated on Cardiovascular death, MI, or stroke at 1 year (HR 1.167, 95% CI 0.742-1.835, p=0.503). Prasugrel and ticagrelor demonstrated similar rates of cardiovascular death, MI, or stroke at 1 year in patients with acute MI (6.6% vs 5.7%; HR 1.167; 95% CI 0.742-1.835; p=0.503).
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