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. 2022 Nov 28;15(22):2270-2280.
doi: 10.1016/j.jcin.2022.09.021.

Ticagrelor vs Prasugrel in a Contemporary Real-World Cohort Undergoing Percutaneous Coronary Intervention

Anoop N Koshy  1 , Gennaro Giustino  2 , Samantha Sartori  2 , Htoo Kyaw  2 , Mayank Yadav  2 , Zhongjie Zhang  2 , Amit Hooda  2 , Ali Farooq  2 , Parasuram Krishnamoorthy  2 , Joseph M Sweeny  2 , Sahil Khera  2 , Gregory W Serrao  2 , Raman Sharma  2 , Javed Suleman  2 , George Dangas  2 , Annapoorna S Kini  2 , Roxana Mehran  3 , Samin K Sharma  4
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Free article

Ticagrelor vs Prasugrel in a Contemporary Real-World Cohort Undergoing Percutaneous Coronary Intervention

Anoop N Koshy et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Potent P2Y12 agents such as ticagrelor and prasugrel are increasingly utilized across the clinical spectrum of patients undergoing percutaneous coronary intervention (PCI). There is a paucity of data supporting their use in a patient population inclusive of both acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) patients.

Objectives: The authors compared the efficacy and safety of ticagrelor and prasugrel in a real-world contemporary PCI cohort.

Methods: Consecutive patients undergoing PCI between 2014 and 2019 discharged on either prasugrel or ticagrelor were included from the prospectively collected institutional PCI registry. Primary endpoint was the composite of death and myocardial infarction (MI), with secondary outcomes including rates of bleeding, stroke, and target vessel revascularization at 1 year.

Results: Overall, 3,858 patients were included in the study (ticagrelor: n = 2,771; prasugrel: n = 1,087), and a majority (48.4%) underwent PCI in the context of CCS. Patients prescribed ticagrelor were more likely to be female, have a history of cerebrovascular disease, and have ACS presentation, while those receiving prasugrel were more likely to be White with a higher prevalence of prior revascularization. No difference in the risk of death or MI was noted across the groups (ticagrelor vs prasugrel: 3.3% vs 3.1%; HR: 0.88; 95% CI: 0.54-1.43; P = 0.59). Rates of target vessel revascularization were significantly lower in the ticagrelor cohort (9.3% vs 14.0%; adjusted HR: 0.71; 95% CI: 0.55-0.91; P = 0.007) with no differences in stroke or bleeding. The results were consistent in patients with CCS (HR: 0.84; 95% CI: 0.46-1.54) and ACS (HR: 1.18; 95% CI: 0.46-1.54), without evidence of interaction (P = 0.37), and confirmed across multivariable adjustment and propensity score stratification analysis.

Conclusions: In this contemporary patient population undergoing PCI, prasugrel and ticagrelor were associated with similar 1-year efficacy and safety.

Keywords: acute coronary syndrome; antiplatelet therapy; chronic coronary syndrome; major adverse cardiovascular event(s); percutaneous coronary intervention; stable ischemic heart disease.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Khera has served as a consultant for Abbott, Medtronic, and Boston Scientific; and has received speaker honoraria from Medtronic. Dr Dangas has received personal fees from Biosensors and Philips. Dr Mehran has received institutional research grants from Abbott, Abiomed, Applied Therapeutics, Arena, AstraZeneca, Bayer, Biosensors, Boston Scientific, Bristol Myers Squibb, CardiaWave, CellAegis, CERC, Chiesi, Concept Medical, CSL Behring, Daiichi Sankyo, Insel Gruppe, Medtronic, Novartis Pharmaceuticals, OrbusNeich, Philips, Transverse Medical, and Zoll; has received personal fees from the American College of Cardiology, Boston Scientific, the California Institute for Regenerative Medicine, Cine-Med Research, Janssen, WebMD, and the Society for Cardiovascular Angiography and Interventions; has received consulting fees paid to the institution from Abbott, Abiomed, AM-Pharma, Alleviant Medical, Bayer, Beth Israel Deaconess, CardiaWave, CeloNova, Chiesi, Concept Medical, Daiichi Sankyo, Duke University, Idorsia Pharmaceuticals, Medtronic, Novartis, and Philips; holds equity (<1%) in Applied Therapeutics, Elixir Medical, STEL, and CONTROLRAD (spouse); and has served on the scientific advisory board for the American Medical Association and Biosensors (spouse). Dr S.K. Sharma has received Speakers Bureau fees from Abbott Vascular, Boston Scientific, and Cardiovascular Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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