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Ticagrelor or Prasugrel in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.
- Source :
-
Circulation . 12/15/2020, Vol. 142 Issue 24, p2329-2337. 9p. - Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>Data on the comparative efficacy and safety of ticagrelor versus prasugrel in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention are limited. We assessed the efficacy and safety of ticagrelor versus prasugrel in a head-to-head comparison in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention.<bold>Methods: </bold>In this prespecified subgroup analysis, we included 1653 patients with ST-segment-elevation myocardial infarction randomized to receive ticagrelor or prasugrel in the setting of the ISAR REACT-5 trial (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 5). The primary end point was the incidence of death, myocardial infarction, or stroke at 1 year after randomization. The secondary end point was the incidence of bleeding defined as BARC (Bleeding Academic Research Consortium) type 3 to 5 bleeding at 1 year after randomization.<bold>Results: </bold>The primary end point occurred in 83 patients (10.1%) in the ticagrelor group and in 64 patients (7.9%) in the prasugrel group (hazard ratio, 1.31 [95% CI, 0.95-1.82]; P=0.10). One-year incidence of all-cause death (4.9% versus 4.7%; P=0.83), stroke (1.3% versus 1.0%; P=0.46), and definite stent thrombosis (1.8% versus 1.0%; P=0.15) did not differ significantly in patients assigned to ticagrelor or prasugrel. One-year incidence of myocardial infarction (5.3% versus 2.8%; hazard ratio, 1.95 [95% CI, 1.18-3.23]; P=0.010) was higher with ticagrelor than with prasugrel. BARC type 3 to 5 bleeding occurred in 46 patients (6.1%) in the ticagrelor group and in 39 patients (5.1%) in the prasugrel group (hazard ratio, 1.22 [95% CI, 0.80-1.87]; P=0.36).<bold>Conclusions: </bold>In patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, there was no significant difference in the primary end point between prasugrel and ticagrelor. Ticagrelor was associated with a significant increase in the risk for recurrent myocardial infarction. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01944800. [ABSTRACT FROM AUTHOR]
- Subjects :
- *PERCUTANEOUS coronary intervention
*MYOCARDIAL infarction
*TICAGRELOR
*PRASUGREL
*MEDICAL equipment
*RESEARCH
*STROKE
*TIME
*RESEARCH methodology
*MEDICAL care
*NEUROTRANSMITTERS
*SURGICAL stents
*MEDICAL cooperation
*EVALUATION research
*CARDIOVASCULAR system
*MEDICAL care research
*DISEASE relapse
*TREATMENT effectiveness
*RISK assessment
*COMPARATIVE studies
*RANDOMIZED controlled trials
*DRUGS
*PLATELET aggregation inhibitors
*HEMORRHAGE
Subjects
Details
- Language :
- English
- ISSN :
- 00097322
- Volume :
- 142
- Issue :
- 24
- Database :
- Academic Search Index
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 147617449
- Full Text :
- https://doi.org/10.1161/CIRCULATIONAHA.120.050244