Prasugrel Bests Ticagrelor in Acute Coronary Syndrome Care

TOPLINE:

Prasugrel is expounded to lower rates of mortality, myocardial infarction (MI), and stroke than ticagrelor below prerequisites of routine care of sufferers discharged after invasive remedy for acute coronary syndrome, with the outcomes being in particular pronounced in these with ST-phase elevation MI (STEMI).

METHODOLOGY:

• Researchers ancient data from a German insurance claims database between January 2012 and December 2021 to emulate the ISAR-REACT5 trial interior routine care settings.
• They incorporated 17,642 propensity salvage–matched adults (mean age, 63.1 years; 26.1% ladies) who had been discharged after an invasive remedy draw for acute coronary syndrome and got both ticagrelor (n = 8821) or prasugrel (n = 8821) in an outpatient environment.
• The kinds of coronary syndromes incorporated STEMI, non-STEMI, and unstable angina (n = 9793, 6558, and 1291, respectively); 98.5% sufferers underwent percutaneous coronary intervention.
• The principle endpoint used to be the composite of all-reason mortality, MI, or stroke interior 1 year of initiation of outpatient remedy with both of the two medicines.
• The secondary endpoints incorporated the particular person ingredients of the principle endpoint along with stent thrombosis; fundamental bleeding used to be incorporated as the protection endpoint.

TAKEAWAY:

• On the 1-year follow-up label, folks receiving ticagrelor showed a higher probability for the principle composite endpoint than these receiving prasugrel (hazard ratio [HR], 1.24; 95% CI, 1.12-1.37).
• Compared with prasugrel, ticagrelor used to be connected to higher incidences of each MI (HR, 1.20; 95% CI, 1.06-1.36) and stroke (HR, 1.33; 95% CI, 1.02-1.74) but no longer all-reason mortality.
• No major differences in stent thrombosis and fundamental bleeding probability had been seen between the two remedy groups.
• In the STEMI subgroup, prasugrel used to be connected to the principle composite pause point in a smaller share of sufferers than ticagrelor (6.8% vs 9.3%); nevertheless, within the non-STEMI and unstable angina subgroups, each pills showed comparable efficacy.

IN PRACTICE:

“This seek for might well furthermore contain implications for the series of P2Y12 receptor inhibitor for [acute coronary syndrome] ingredients, in particular in sufferers with STEMI, as circuitously supported by data from assorted trials,” the authors of the seek for wrote. “Overall, this seek for supports guiding principle solutions preferring prasugrel over ticagrelor in sufferers with acute MI who’re supposed to endure an invasive remedy draw,” they added.

SOURCE:

The seek for used to be led by Nils Krüger, MD, of the German Coronary heart Middle Munich, Munich, Germany. It used to be published online on December 02, 2024, in JAMA Network Originate.

LIMITATIONS: 

The observational create of the seek for shrimp the flexibility to blueprint causal inferences due to ability confounding components. The seek for might well likely no longer assess the fair of aspirin due to unreliable seize of using over-the-counter pills. The expend of a German health claims database might well furthermore contain restricted the generalizability of the findings to assorted populations and healthcare programs.

DISCLOSURES:

This seek for used to be supported by grants from the Bavarian Declare Ministry of Health, Care and Prevention and the Bavarian Declare Ministry of Science and the Arts. Additional enhance used to be supplied by grants from the German Federal Ministry of Economics and Vitality, the Horizon Europe Framework Programme, and various sources. Some authors reported receiving grants, private fees, honoraria, and speaker fees from varied institutions and pharmaceutical companies originate air the submitted work.

This article used to be created using several editorial instruments, along with AI, as fragment of the draw. Human editors reviewed this insist prior to newsletter.