Prasugrel superior to ticagrelor in reducing risk of death, MI, stroke in NSTE-ACS patients

Prasugrel appears to do better than ticagrelor in attenuating the combined 1-year risk of death, myocardial infarction (MI), and stroke without increasing bleeding risk in patients with non-ST-segment elevation (NSTE) acute coronary syndrome (ACS), a recent study has shown.

“Current guidelines recommend intensified platelet inhibition by prasugrel or ticagrelor in patients with unstable angina or NSTEMI,” the authors said.

This posthoc analysis combined the prespecified subgroups of unstable angina and NSTEMI from the randomized ISAR-REACT 5 trial. A total of 1,179 patients assigned to ticagrelor and 1,186 to prasugrel were included in the study. Ticagrelor was initiated immediately after randomization and prasugrel after coronary angiography.

The primary endpoint of a composite of death, MI, or stroke during 1-year follow-up occurred in 101 (8.7 percent) patients in the ticagrelor group and in 73 (7.3 percent) in the prasugrel group (hazard ratio [HR], 1.41, 95 percent confidence interval [CI], 1.04–1.90). The HRs for all-cause death and MI were 1.43 (95 percent CI, 0.93–2.21) and 1.43 (95 percent CI, 0.94–2.19), respectively.

The safety endpoint of Bleeding Academic Research Consortium class 3–5 was reached in 49 (5.2 percent) patients in the ticagrelor group and in 41 (4.7 percent) in the prasugrel group (HR, 1.09, 95 percent CI, 0.72–1.65).

The efficacy advantage with prasugrel persisted after the first month in landmark analysis.

Due to the posthoc design of the analysis, further research is warranted to confirm these findings, the authors noted.