Ticagrelor Superior After PCI for Acute Coronary Syndrome

The following article is a part of conference coverage from the American Heart Association Scientific Sessions 2021, being held virtually from November 13 to 15, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA Scientific Sessions 2021.

Compared with clopidogrel and prasugrel, ticagrelor was associated with a lower bleeding risk in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), according to study results presented at the American Heart Association (AHA) Scientific Sessions 2021, held from November 13 to 15, 2021.

Following PCI for ACS, dual antiplatelet therapy with a P2Y₁₂ inhibitor and aspirin is recommended. The current study compared the safety and efficacy of clopidogrel, prasugrel, and ticagrelor in a large national cohort of participants with first-time ACS undergoing PCI within 7 or fewer days of admission. All patients (N=26,997) filled a P2Y₁₂ inhibitor prescription within 30 days or less of the index event.

The primary study outcome was MACE, which was a composite of recurrent myocardial infarction, stroke, cardiovascular death, or repeat revascularization at 12 months. Bleeding requiring hospitalization at 12 months was the safety outcome. The standardized absolute and relative risks across sex, age, bleeding, comorbidity, and concomitant anticoagulant therapy distributions were calculated using multivariable logistic regression.

Among the total 26,997 participants, 6585 (median age 70) were prescribed clopidogrel at discharge, 18,425 (median age 64) were prescribed ticagrelor, and 1987 (median age 59) were prescribed prasugrel (P <.001). The clopidogrel group was more likely to have had prior bleeding episodes (P <.001). Adjusted relative risks for MACE were 1.05 for prasugrel vs ticagrelor (P =.22); 0.85 for prasugrel vs clopidogrel (P <.001); and 0.80 for ticagrelor vs clopidogrel (P <.001).

Adjusted relative risks of bleeding were 1.30 for prasugrel vs ticagrelor (P =.03); 1.07 for prasugrel vs clopidogrel (P =.56); and 0.82 for ticagrelor vs clopidogrel (P =.001). The absolute differences in bleeding risk among the groups were modest, though statistically significant (prasugrel 2.9%; clopidogrel 2.7%; ticagrelor 2.2%).

“Ticagrelor and prasugrel were associated with lower risk [for] MACE than clopidogrel but did not significantly differ from each other. Ticagrelor was associated with a lower risk of bleeding than both clopidogrel and prasugrel,” the study authors concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Godtfredsen SJ, Pareek M, Leutscher P, et al. Superior effectiveness and safety of ticagrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a nationwide registry-based study. Presented at: AHA Scientific Sessions 2021; November 13-15, 2021. Poster P5.