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

Venetsanos, Dimitrios ; Träff, Erik ; Erlinge, David LU orcid ; Hagström, Emil ; Nilsson, Johan ; Desta, Liyew ; Lindahl, Bertil ; Mellbin, Linda ; Omerovic, Elmir and Szummer, Karolina Elisabeth , et al. (2021) In Heart 107(14). p.1145-1151
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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute coronary syndrome, percutaneous coronary intervention
in
Heart
volume
107
issue
14
pages
7 pages
publisher
BMJ Publishing Group
external identifiers
  • pmid:33712510
  • scopus:85102492050
ISSN
1355-6037
DOI
10.1136/heartjnl-2020-318694
language
English
LU publication?
yes
id
18b0a8a6-5189-49c7-92d2-903c87bb4843
date added to LUP
2021-03-29 14:44:03
date last changed
2024-06-29 09:58:30
@article{18b0a8a6-5189-49c7-92d2-903c87bb4843,
  abstract     = {{<p>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. </p>}},
  author       = {{Venetsanos, Dimitrios and Träff, Erik and Erlinge, David and Hagström, Emil and Nilsson, Johan and Desta, Liyew and Lindahl, Bertil and Mellbin, Linda and Omerovic, Elmir and Szummer, Karolina Elisabeth and Zwackman, Sammy and Jernberg, Tomas and Alfredsson, Joakim}},
  issn         = {{1355-6037}},
  keywords     = {{acute coronary syndrome; percutaneous coronary intervention}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{14}},
  pages        = {{1145--1151}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Heart}},
  title        = {{Prasugrel versus ticagrelor in patients with myocardial infarction undergoing percutaneous coronary intervention}},
  url          = {{http://dx.doi.org/10.1136/heartjnl-2020-318694}},
  doi          = {{10.1136/heartjnl-2020-318694}},
  volume       = {{107}},
  year         = {{2021}},
}