1-Year Outcomes of Patients Undergoing Primary Angioplasty for Myocardial Infarction Treated With Prasugrel Versus Ticagrelor
Language English Country United States Media print-electronic
Document type Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
PubMed
29154813
DOI
10.1016/j.jacc.2017.11.008
PII: S0735-1097(17)41524-5
Knihovny.cz E-resources
- Keywords
- myocardial infarction, outcome, prasugrel, primary percutaneous coronary intervention, switch, ticagrelor,
- MeSH
- Time Factors MeSH
- Myocardial Infarction diagnosis mortality therapy MeSH
- Platelet Aggregation Inhibitors therapeutic use MeSH
- Clopidogrel therapeutic use MeSH
- Percutaneous Coronary Intervention * MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Prasugrel Hydrochloride therapeutic use MeSH
- Aged MeSH
- Ticagrelor therapeutic use MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
- Names of Substances
- Platelet Aggregation Inhibitors MeSH
- Clopidogrel MeSH
- Prasugrel Hydrochloride MeSH
- Ticagrelor MeSH
BACKGROUND: Early outcomes of patients in the PRAGUE-18 (Comparison of Prasugrel and Ticagrelor in the Treatment of Acute Myocardial Infarction) study did not find any significant differences between 2 potent P2Y12 inhibitors. OBJECTIVES: The 1-year follow-up of the PRAGUE-18 study focused on: 1) a comparison of efficacy and safety between prasugrel and ticagrelor; and 2) the risk of major ischemic events related to an economically motivated post-discharge switch to clopidogrel. METHODS: A total of 1,230 patients with acute myocardial infarction (MI) treated with primary percutaneous coronary intervention were randomized to prasugrel or ticagrelor with an intended treatment duration of 12 months. The combined endpoint was cardiovascular death, MI, or stroke at 1 year. Because patients had to cover the costs of study medication after hospital discharge, some patients decided to switch to clopidogrel. RESULTS: The endpoint occurred in 6.6% of prasugrel patients and in 5.7% of ticagrelor patients (hazard ratio: 1.167; 95% confidence interval: 0.742 to 1.835; p = 0.503). No significant differences were found in: cardiovascular death (3.3% vs. 3.0%; p = 0.769), MI (3.0% vs. 2.5%; p = 0.611), stroke (1.1% vs. 0.7%; p = 0.423), all-cause death (4.7% vs. 4.2%; p = 0.654), definite stent thrombosis (1.1% vs. 1.5%; p = 0.535), all bleeding (10.9% vs. 11.1%; p = 0.999), and TIMI (Thrombolysis In Myocardial Infarction) major bleeding (0.9% vs. 0.7%; p = 0.754). The percentage of patients who switched to clopidogrel for economic reasons was 34.1% (n = 216) for prasugrel and 44.4% (n = 265) for ticagrelor (p = 0.003). Patients who were economically motivated to switch to clopidogrel had (compared with patients who continued the study medications) a lower risk of major cardiovascular events; however, they also had lower ischemic risk. CONCLUSIONS: Prasugrel and ticagrelor are similarly effective during the first year after MI. Economically motivated early post-discharge switches to clopidogrel were not associated with an increased risk of ischemic events. (Comparison of Prasugrel and Ticagrelor in the Treatment of Acute Myocardial Infarction [PRAGUE-18]; NCT02808767).
1st Internal Cardiology Clinic University Hospital Olomouc Olomouc Czech Republic
Cardiocentre Department of Cardiology Regional Hospital Ceske Budejovice Czech Republic
Cardiology Centre AGEL Pardubice Czech Republic
Cardiovascular Department University Hospital Ostrava Czech Republic
References provided by Crossref.org
Prognostic Value of MicroRNAs in Patients after Myocardial Infarction: A Substudy of PRAGUE-18
ClinicalTrials.gov
NCT02808767
