1
|
Lahu S, Scalamogna M, Ndrepepa G, Menichelli M, Valina C, Hemetsberger R, Witzenbichler B, Bernlochner I, Joner M, Xhepa E, Hapfelmeier A, Kufner S, Sager HB, Mayer K, Kessler T, Laugwitz K, Richardt G, Schunkert H, Neumann F, Kastrati A, Cassese S. Prior Myocardial Infarction and Treatment Effect of Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndromes - A Post-hoc Analysis of the ISAR-REACT 5 Trial. J Am Heart Assoc 2022; 11:e027257. [PMID: 36515247 PMCID: PMC9798807 DOI: 10.1161/jaha.122.027257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndrome and prior myocardial infarction (MI) remain unstudied. We aimed to assess the treatment effect of ticagrelor versus prasugrel according to prior MI status in patients with ACS. Methods and Results Patients with acute coronary syndrome planned for an invasive strategy and randomized to ticagrelor or prasugrel in the ISAR-REACT (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment) 5 trial were included. The primary end point was the composite of 1-year all-cause death, MI, or stroke; the secondary safety end point was the composite of 1-year Bleeding Academic Research Consortium type 3 to 5 bleeding. The study included 4015 patients (prior MI=631 patients; no prior MI=3384 patients). As compared with patients without prior MI, the primary end point occurred more frequently in patients with prior MI (12.6% versus 7.2%; hazard ratio [HR], 1.78 [95% CI, 1.38-2.29]); the secondary safety end point appears to differ little between patients with and without prior MI (5.8% versus 5.7%, respectively; HR, 1.02 [95% CI, 0.71-1.45]). With regard to the primary end point, ticagrelor versus prasugrel was associated with an HR of 1.62 (95% CI, 1.03-2.55) in patients with prior MI and an HR of 1.28 (95% CI, 0.99-1.65) in patients without prior MI (Pint=0.37). With regard to the secondary safety end point, ticagrelor versus prasugrel was associated with an HR of 1.28 (95% CI, 0.56-2.91) in patients with prior MI and an HR of 1.13 (95% CI, 0.82-1.55) in patients without prior MI (Pint=0.79). Conclusions Patients with acute coronary syndrome and prior MI are at higher risk for recurrent ischemic but not bleeding events. Prasugrel is superior to ticagrelor in reducing the risk of ischemic events without a tradeoff in bleeding regardless of prior MI status. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01944800.
Collapse
Affiliation(s)
- Shqipdona Lahu
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart AllianceMunichGermany
| | - Maria Scalamogna
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany,Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Gjin Ndrepepa
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany
| | | | - Christian Valina
- Department of Cardiology and Angiology IIUniversity Heart Center Freiburg ‐ Bad Krozingen, Standort Bad KrozingenBad KrozingenGermany
| | - Rayyan Hemetsberger
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad SegebergBad SegebergGermany
| | | | - Isabell Bernlochner
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart AllianceMunichGermany,Medizinische Klinik und Poliklinik Innere Medizin I (Kardiologie, Angiologie, Pneumologie), Klinikum rechts der IsarMunichGermany
| | - Michael Joner
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart AllianceMunichGermany
| | - Erion Xhepa
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany
| | - Alexander Hapfelmeier
- Technical University of Munich, School of MedicineInstitute of AI and Informatics in MedicineMunichGermany,Technical University of Munich, School of MedicineInstitute of General Practice and Health Services ResearchMunichGermany
| | - Sebastian Kufner
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany
| | - Hendrik B. Sager
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart AllianceMunichGermany
| | - Katharina Mayer
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany
| | - Thorsten Kessler
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart AllianceMunichGermany
| | - Karl‐Ludwig Laugwitz
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart AllianceMunichGermany,Medizinische Klinik und Poliklinik Innere Medizin I (Kardiologie, Angiologie, Pneumologie), Klinikum rechts der IsarMunichGermany
| | - Gert Richardt
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad SegebergBad SegebergGermany
| | - Heribert Schunkert
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart AllianceMunichGermany
| | - Franz‐Josef Neumann
- Department of Cardiology and Angiology IIUniversity Heart Center Freiburg ‐ Bad Krozingen, Standort Bad KrozingenBad KrozingenGermany
| | - Adnan Kastrati
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart AllianceMunichGermany
| | - Salvatore Cassese
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany
| |
Collapse
|
2
|
Lahu S, Ndrepepa G, Neumann FJ, Menichelli M, Bernlochner I, Richardt G, Wöhrle J, Witzenbichler B, Hemetsberger R, Mayer K, Akin I, Cassese S, Gewalt S, Xhepa E, Kufner S, Valina C, Sager HB, Joner M, Ibrahim T, Laugwitz KL, Schunkert H, Schüpke S, Kastrati A. Pre-admission antiplatelet therapy and treatment effect of ticagrelor vs. prasugrel in patients with acute coronary syndromes-a subgroup analysis of the ISAR-REACT 5 trial. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:687-694. [PMID: 35191982 DOI: 10.1093/ehjcvp/pvac007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/18/2022] [Indexed: 06/14/2023]
Abstract
AIMS To assess whether the efficacy and safety of ticagrelor vs. prasugrel in patients with acute coronary syndromes (ACSs) are influenced by pre-admission treatment with aspirin and/or clopidogrel. METHODS AND RESULTS Patients (n = 4018) were categorized into two groups: pre-admission aspirin and/or clopidogrel group (n = 1455) and no pre-admission aspirin or clopidogrel group (n = 2563). The primary endpoint was the composite of all-cause death, myocardial infarction, or stroke; the secondary safety endpoint was Bleeding Academic Research Consortium (BARC) type 3-5 bleeding, both at 1 year. Patients in the pre-admission aspirin and/or clopidogrel group had a higher risk of ischaemic events, but a similar risk of bleeding to patients in the no pre-admission aspirin or clopidogrel group (cumulative incidences 10.5% vs. 6.7%, and 5.7% vs. 5.7%, respectively). The primary endpoint occurred in 81/717 patients assigned to ticagrelor and 69/738 patients assigned to prasugrel in the pre-admission aspirin and/or clopidogrel group [11.5% vs. 9.5%; hazard ratio (HR) = 1.23; 95% confidence interval (CI) 0.89-1.69], and in 103/1295 patients assigned to ticagrelor and 68/1268 patients assigned to prasugrel in the no pre-admission aspirin or clopidogrel group [8.0% vs. 5.4%; HR = 1.50 (1.10-2.03); Pint = 0.38]. BARC type 3-5 bleeding events did not differ between ticagrelor and prasugrel in patients in the pre-admission aspirin and/or clopidogrel (6.2% vs. 4.5%) or no pre-admission aspirin or clopidogrel (5.3% vs. 5.1%) group (Pint = 0.54). CONCLUSION In patients with ACS, pre-admission therapy with aspirin and/or clopidogrel has no influence on the relative efficacy and safety of ticagrelor and prasugrel.
Collapse
Affiliation(s)
- Shqipdona Lahu
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Isabell Bernlochner
- I. Medizinische Klinik und Poliklinik Innere Medizin, Klinikum Rechts der Isar, Munich, Germany
| | | | - Jochen Wöhrle
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany
| | | | | | - Katharina Mayer
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Senta Gewalt
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Valina
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Hendrik B Sager
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tareq Ibrahim
- I. Medizinische Klinik und Poliklinik Innere Medizin, Klinikum Rechts der Isar, Munich, Germany
| | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik und Poliklinik Innere Medizin, Klinikum Rechts der Isar, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Stefanie Schüpke
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| |
Collapse
|