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. 2020 Oct 12;13(19):2238-2247.
doi: 10.1016/j.jcin.2020.07.032.

Ticagrelor or Prasugrel in Patients With Acute Coronary Syndromes and Diabetes Mellitus

Gjin Ndrepepa  1 , Adnan Kastrati  2 , Maurizio Menichelli  3 , Franz-Josef Neumann  4 , Jochen Wöhrle  5 , Isabell Bernlochner  6 , Gert Richardt  7 , Bernhard Witzenbichler  8 , Dirk Sibbing  9 , Senta Gewalt  1 , Dominick J Angiolillo  10 , Christian W Hamm  11 , Alexander Hapfelmeier  12 , Dietmar Trenk  4 , Karl-Ludwig Laugwitz  6 , Heribert Schunkert  13 , Stefanie Schüpke  13 , Katharina Mayer  1
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Free article

Ticagrelor or Prasugrel in Patients With Acute Coronary Syndromes and Diabetes Mellitus

Gjin Ndrepepa et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: The aim of this study was to assess the efficacy and safety of ticagrelor versus prasugrel in patients with diabetes mellitus (DM) presenting with acute coronary syndromes (ACS) in whom invasive therapy was planned.

Background: The efficacy and safety of ticagrelor versus prasugrel in patients with ACS with DM undergoing invasive treatment remain unknown.

Methods: This pre-specified analysis of the ISAR-REACT (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment) 5 trial included 892 patients with ACS with DM and 3,124 patients with ACS without DM randomized to prasugrel or ticagrelor. The primary endpoint was a composite of death, myocardial infarction, or stroke; the safety endpoint was Bleeding Academic Research Consortium types 3 to 5 bleeding (both assessed 12 months after randomization).

Results: The primary endpoint occurred in 51 patients (11.2%) in the ticagrelor group and 55 patients (13.0%) in the prasugrel group in the DM cohort (hazard ratio: 0.84; 95% confidence interval: 0.58 to 1.24; p = 0.383) and in 132 patients (8.6%) in the ticagrelor group and 81 patients (5.2%) in the prasugrel group in the non-DM cohort (hazard ratio: 1.70; 95% confidence interval: 1.29 to 2.24; p < 0.001). There was a significant treatment arm-by-diabetic status interaction (pint = 0.0035). Bleeding Academic Research Consortium types 3 to 5 bleeding occurred in 27 patients (6.9%) in the ticagrelor group and 19 patients (5.5%) in the prasugrel group (p = 0.425) in the DM cohort and in 68 patients (5.2%) in the ticagrelor group and 60 patients (4.6%) in the prasugrel group in the non-DM cohort (p = 0.500).

Conclusions: DM seems to affect the efficacy of ticagrelor and prasugrel in patients with ACS. In patients with DM, the efficacy of ticagrelor was comparable with that of prasugrel. (Prospective, Randomized Trial of Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome [ISAR-REACT 5]; NCT01944800).

Keywords: acute coronary syndrome; diabetes; percutaneous coronary intervention; prasugrel; ticagrelor.

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