Safety and Efficacy in Prasugrel- Versus Ticagrelor-Treated Patients With ST-Elevation Myocardial Infarction.

Abstract

Prasugrel and ticagrelor are recommended over clopidogrel in patients with ST-elevation myocardial infarction (STEMI). In this registry analysis, we compared efficacy and safety of ticagrelor and prasugrel P2Y12 inhibition in patients with STEMI. We included 318 patients in this single-center analysis. Twelve-month follow-up was conducted during ambulatory care at our department. Patients were on dual antiplatelet therapy with aspirin and ticagrelor or prasugrel during the follow-up period. Prescription of prasugrel or ticagrelor, respectively, was according to the preference of the treating physician. Major adverse cardiac and cerebrovascular events (MACCE) [death, myocardial infarction (MI), stroke, and unplanned reintervention] and thrombolysis in myocardial infarction (TIMI) bleeding (major/minor) were registered during hospitalization and follow-up. TIMI bleeding events were more frequent in ticagrelor-treated patients [17 vs. 5 patients, hazard ratio (HR) 2.85, 95% confidence interval (CI) 1.2-6.6; log-rank P value = 0.01]. Prasugrel-treated patients were significantly younger (ticagrelor 63 ± 12 years vs. prasugrel 57 ± 10; P < 0.0001). Besides that, patients' characteristics were similar in both groups. Multivariate analysis revealed that ticagrelor medication was independently associated with bleeding risk after adjustment for age, percutaneous coronary intervention approach (femoral vs. radial), diabetes mellitus, and kidney function (HR 3.01; 95% CI 1.0-7.4; P = 0.043). In patients treated with ticagrelor, 35 MACCE were detected. There was no difference as compared to prasugrel-treated patients (24 events, HR 1.24, 95% CI 0.79-2.09; log-rank P value = 0.41). TIMI bleeding events were more frequent in ticagrelor-treated patients with STEMI during 12-month follow-up. There were no differences in MACCE between groups in this registry analysis.

• Authors: Dimitrios Dimitroulis, Milad Golabkesh, David Naguib, Betül Knoop, Lisa Dannenberg, Carolin Helten, Martin Pöhl, Christian Jung, Malte Kelm, Tobias Zeus, Amin Polzin
• Journal: Journal of cardiovascular pharmacology (J Cardiovasc Pharmacol) Vol. 72 Issue 4 Pg. 186-190 (10 2018) ISSN: 1533-4023 [Electronic] United States
• PMID: 29985284 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Purinergic P2Y Receptor Antagonists
• Prasugrel Hydrochloride
• Ticagrelor
• Aspirin

Topics

• Aged
• Aspirin (therapeutic use)
• Drug Therapy, Combination
• Female
• Germany
• Hemorrhage (chemically induced)
• Humans
• Male
• Middle Aged
• Percutaneous Coronary Intervention (adverse effects)
• Pilot Projects
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Prasugrel Hydrochloride (adverse effects, therapeutic use)
• Purinergic P2Y Receptor Antagonists (adverse effects, therapeutic use)
• Recurrence
• Registries
• Risk Factors
• ST Elevation Myocardial Infarction (blood, diagnosis, therapy)
• Stroke (etiology)
• Ticagrelor (adverse effects, therapeutic use)
• Time Factors
• Treatment Outcome