Image of a heart with myocardial infarction

Prasugrel and ticagrelor associated with similar efficacy and safety following myocardial infarction

By Ahmed El-Medany

In a large retrospective study by Venetsanos et al, researchers analysed 37,990 patients from the SWEDEHEART registry with myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI) to compare the clinical outcomes of prasugrel (Effient, Daiichi Sankyo/Eli Lilly) and ticagrelor (Brilinta, AstraZeneca).

Outcomes of interest included 1-year major adverse cardiac events (MACE – defined as death/MI/stroke), and major bleeding.  Researchers utilised multivariable adjustment, inverse probability of treatment weighting and propensity-score matching to adjust for confounders.

No differences were found between prasugrel and ticagrelor in risk for MACE (6.1% for both groups; adjusted HR = 1.03; 95% CI, 0.86-1.24). Moreover, there was no significant difference in the risk for all-cause mortality (cumulative rate, 2.3% vs. 2.9%, respectively; adjusted HR = 0.89; 95% CI, 0.67-1.2), recurrent MI (cumulative rate, 4.1% vs. 3.2%, respectively; adjusted HR= 1.26; 95% CI, 0.98-1.58) or stroke (cumulative rate, 0.9% vs. 1.1%, respectively; adjusted HR = 0.94; 95% CI, 0.58-1.53) as well as no significant difference in major bleeding risk (2.5% vs. 3.2%; adjusted HR= 0.92; 95% CI, 0.69-1.22).

Venetsanos D, Träff E, Erlinge D, et al. Prasugrel versus ticagrelor in patients with myocardial infarction undergoing percutaneous coronary intervention.

Heart Published Online First: 12 March 2021. doi: 10.1136/heartjnl-2020-318694