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. 2021 Jul;107(14):1145-1151.
doi: 10.1136/heartjnl-2020-318694. Epub 2021 Mar 12.

Prasugrel versus ticagrelor in patients with myocardial infarction undergoing percutaneous coronary intervention

Dimitrios Venetsanos  1 , Erik Träff  2 , David Erlinge  3 , Emil Hagström  4   5 , Johan Nilsson  6 , Liyew Desta  7 , Bertil Lindahl  4 , Linda Mellbin  7 , Elmir Omerovic  8 , Karolina Elisabeth Szummer  9 , Sammy Zwackman  2 , Tomas Jernberg  10 , Joakim Alfredsson  2
Affiliations

Prasugrel versus ticagrelor in patients with myocardial infarction undergoing percutaneous coronary intervention

Dimitrios Venetsanos et al. Heart. 2021 Jul.

Abstract

Objective: The comparative efficacy and safety of prasugrel and ticagrelor in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) remain unclear. We aimed to investigate the association of treatment with clinical outcomes.

Methods: In the SWEDEHEART (Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies) registry, all patients with MI treated with PCI and discharged on prasugrel or ticagrelor from 2010 to 2016 were included. Outcomes were 1-year major adverse cardiac and cerebrovascular events (MACCE, death, MI or stroke), individual components and bleeding. Multivariable adjustment, inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to adjust for confounders.

Results: We included 37 990 patients, 2073 in the prasugrel group and 35 917 in the ticagrelor group. Patients in the prasugrel group were younger, more often admitted with ST elevation MI and more likely to have diabetes. Six to twelve months after discharge, 20% of patients in each group discontinued the P2Y12 receptor inhibitor they received at discharge. The risk for MACCE did not significantly differ between prasugrel-treated and ticagrelor-treated patients (adjusted HR 1.03, 95% CI 0.86 to 1.24). We found no significant difference in the adjusted risk for death, recurrent MI or stroke alone between the two treatments. There was no significant difference in the risk for bleeding with prasugrel versus ticagrelor (2.5% vs 3.2%, adjusted HR 0.92, 95% CI 0.69 to 1.22). IPTW and PSM analyses confirmed the results.

Conclusion: In patients with MI treated with PCI, prasugrel and ticagrelor were associated with similar efficacy and safety during 1-year follow-up.

Keywords: acute coronary syndrome; percutaneous coronary intervention.

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Conflict of interest statement

Competing interests: DV reports a grant from Boston Scientific, outside the submitted work. DE reports speaker fees from AstraZeneca and Bayer and serves in the advisor board for Bayer and Boehringer Ingelheim, outside the submitted work. EH reports grants and honoraria from Amgen, Sanofi, Bayer and NovoNordisk, outside the submitted work. LM reports consulting fees/lecture from AstraZeneca, Bayer, Boehringer Ingelheim Novartis, NovoNordisk, MSD, Sanofi and Amgen, outside the submitted work. EO reports institutional research grant from AstraZeneca and consulting fees from Novartis, MSD, AstraZeneca and Bayer, outside the submitted work. TJ reports research grants from MSD and Novartis, outside the submitted work. JA reports grants and lecture fees from AstraZeneca, Lilly, Pfizer, Bayer, Novartis and Boehringer Ingelheim, and serving on advisory board for AstraZeneca, Novartis and MSD, outside the submitted work.

Figures

Figure 1
Figure 1
Temporal changes in the utilisation of prasugrel and ticagrelor during the study period.
Figure 2
Figure 2
Cumulative rate of adverse events stratified by treatment. Kaplan-Meier curves present the cumulative rates of major adverse cardiac and cerebrovascular events (MACCE) and net adverse cardiac and cerebrovascular events (NACCE), stratified by treatment.
Figure 3
Figure 3
Subgroup analysis. Renal failure was defined as estimated glomerular filtration rate under 60 mL/min/1.72 m2. NSTEMI, non-ST segment elevation myocardial infarction; STEMI, ST segment elevation myocardial infarction.
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