Prasugrel outperforms ticagrelor among PCI patients

Prasugrel is associated with better outcomes than ticagrelor when treating acute coronary syndrome (ACS) patients who undergo percutaneous coronary intervention (PCI), according to new findings published in JAMA Cardiology.

The study’s authors evaluated data from the ISAR-REACT 5 trial, focusing on more than 3,000 patients presenting with ACS and treated with PCI from September 2013 to February 2018. The primary endpoint was a composite of all-cause mortality, myocardial infarction and stroke after one full year. Its safety endpoint was Bleeding Academic Researching Consortium (BARC) type three to five bleeding.

“This analysis is, to our knowledge, the first study to directly compare outcomes between ticagrelor-based and prasugrel-based strategies in patients with ACS who are treated with PCI,” wrote lead author J. J. Coughlan, MB, BCh, a specialist at the Technical University of Munich in Germany, and colleagues. “The PCI procedure for these patients reflected contemporary practice with new-generation drug-eluting stents.”

While 1,676 patients with a mean age of 64.4 years old received ticagrelor, 1,701 patients with a mean age of 64.7 years old received prasugrel. Overall, the study’s primary endpoint occurred in 9.8% of patients from the ticagrelor group and 7.1% of the prasugrel group. Myocardial infarctions were observed in 5.3% of the ticagrelor group and 3.8% of the prasugrel group. The study’s safety endpoint occurred in 5.3% of patients from the ticagrelor group and 4.9% of the prasugrel group.

“Overall, these data support the preference for a prasugrel-based strategy vs a ticagrelor-based strategy in patients presenting with ACS who are treated with PCI,” the authors concluded. “Because these observations are based on a post-randomization subgroup, these findings should be regarded as hypothesis generating, and dedicated randomized clinical trials may be warranted to confirm these findings.”

Click here for the full analysis.

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