Ticagrelor or Prasugrel in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes
Ticagrelor or Prasugrel in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes
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DOI：
10.1016/j.jacc.2020.09.584
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发表时间：
2020-11-24
影响因子：
24
通讯作者：
Kastrati, Adnan
中科院分区：
文献类型：
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作者：
Valina, Christian;Neumann, Franz-Josef;Kastrati, Adnan
背景目前的指南推荐在不稳定型心绞痛（UA）或非ST段抬高型（NSTE）心肌梗死（MI）患者中使用普拉格雷或替格瑞洛强化血小板抑制。方法：该事后分析结合了随机ISAR-REACT 5试验中预先指定的UA和NSTEMI亚组。它包括1，179名被分配到替格瑞洛的患者和1，186名被分配到普拉格雷的患者。随机化后立即开始替格瑞洛治疗，冠脉造影后开始普拉格雷治疗。主要终点为1年随访期间死亡、心肌梗死或卒中的复合终点，安全性终点为出血学术研究联盟3- 5级。（8.7%）替格瑞洛组和73例普拉格雷组有6.3%的患者（风险比[HR]：1.41; 95%置信区间[CI]：1.04至1.90）。全因死亡的HR为1.43（95% CI：0.93 - 2.21），MI为1.43（95% CI：0.94 - 2.19）。替格瑞洛组49例（5.2%）患者和普拉格雷组41例（4.7%）患者发生安全性终点（HR：1.09; 95% CI：0.72 - 1.65）。地标分析显示持续性的疗效优势与普拉格雷后的第一个months.CONCLUSIONS在NSTE-ACS患者中，我们发现，普拉格雷是上级替格瑞洛在降低合并1年的死亡，心肌梗死和中风的风险，而不增加出血的风险。由于分析的事后性质，这些发现需要进一步研究证实。（替格瑞洛与普拉格雷在急性冠脉综合征患者中的前瞻性随机试验; NCT 01944800）（C）2020由爱思唯尔代表美国心脏病学会基金会发表。
BACKGROUND Current guidelines recommend intensified platelet inhibition by prasugrel or ticagrelor in patients with unstable angina (UA) or non-ST-segment elevation (NSTE) myocardial infarction (MI).OBJECTIVES This study sought to investigate the benefits and risks of ticagrelor as compared with prasugrel in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and planned invasive management.METHODS This post hoc analysis combines the pre-specified subgroups of UA and NSTEMI of the randomized ISAR-REACT 5 trial. It included 1,179 patients assigned to ticagrelor and 1,186 assigned to prasugrel. Ticagrelor was started immediately after randomization and prasugrel after coronary angiography. The primary endpoint was a composite of death, MI, or stroke during 1-year follow-up, and the safety endpoint was Bleeding Academic Research Consortium class 3-5.RESULTS The primary endpoint was reached in 101 (8.7%) patients in the ticagrelor and in 73 (6.3%) patients in the prasugrel group (hazard ratio [HR]: 1.41; 95% confidence interval [CI]: 1.04 to 1.90). The HR for all-cause death was 1.43 (95% CI: 0.93 to 2.21) and that for MI 1.43 (95% CI: 0.94 to 2.19). The safety endpoint occurred in 49 (5.2%) patients in the ticagrelor and in 41 (4.7%) patients in the prasugrel group (HR: 1.09; 95% CI: 0.72 to 1.65). Landmark analysis revealed persistence of the efficacy advantage with prasugrel after the first month.CONCLUSIONS In patients with NSTE-ACS, we found that prasugrel was superior to ticagrelor in reducing the combined 1-year risk of death, MI, and stroke without increasing the risk of bleeding. Due to the post hoc nature of the analysis, these findings need confirmation by further studies. (Prospective, Randomized Trial of Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome; NCT01944800) (C) 2020 Published by Elsevier on behalf of the American College of Cardiology Foundation.