Real-World Data of Prasugrel vs. Ticagrelor in Acute Myocardial Infarction: Results from the RENAMI Registry.

Ovidio De Filippo, Martina Cortese, Fabrizio D Ascenzo, Sergio Raposeiras-Roubin, Emad Abu-Assi, Tim Kinnaird, Albert Ariza-Solé, Sergio Manzano-Fernández, Christian Templin, Lazar Velicki, Ioanna Xanthopoulou, Enrico Cerrato, Andrea Rognoni, Giacomo Boccuzzi, Antonio Montefusco, Andrea Montabone, Salma Taha, Alessandro Durante, Sebastiano Gili, Giulia Magnani, Michele Autelli, Alberto Grosso, Pedro Flores Blanco, Alberto Garay, Giorgio Quadri, Ferdinando Varbella, Berenice Caneiro Queija, Rafael Cobas Paz, María Cespón Fernández, Isabel Muñoz Pousa, Diego Gallo, Umberto Morbiducci, Alberto Dominguez-Rodriguez, Mariano Valdés, Angel Cequier, Dimitrios Alexopoulos, Andrés Iñiguez-Romo, Mauro Rinaldi

REVIEW


11 July 2019

Very relevant topic area but a larger sample would be required to assess whether the effect is different in specific subgroups (e.g. diabetes)


RELEVANCE 2
INNOVATIVENESS 3
APPLICABILITY 2
OVERALL 2

PAPER DETAILS


TITLE

Real-World Data of Prasugrel vs. Ticagrelor in Acute Myocardial Infarction: Results from the RENAMI Registry.

ABSTRACT

BACKGROUND
Limited data are available concerning differences in clinical outcomes for real-life patients treated with ticagrelor versus prasugrel after percutaneous coronary intervention (PCI).

OBJECTIVE
Our objective was to determine and compare the efficacy and safety of ticagrelor and prasugrel in a real-world population.

METHODS
RENAMI was a retrospective, observational registry including the data and outcomes of consecutive patients with acute coronary syndrome (ACS) who underwent primary PCI and were discharged with dual antiplatelet therapy (DAPT) between January 2012 and January 2016. The mean follow-up period was 17 ± 9 months. In total, 11 university hospitals from six European countries participated. After propensity-score matching, there were no substantial differences in the baseline clinical and interventional features. All patients were treated with acetylsalicylic acid plus prasugrel 10 mg once daily or acetylsalicylic acid plus ticagrelor 90 mg twice daily. Mean duration of DAPT was 12.04 ± 3.4 months with prasugrel and 11.90 ± 4.1 months with ticagrelor (p = 0.47). The primary and secondary endpoints were long-term net adverse clinical events (NACE) and major adverse cardiovascular events (MACE), respectively, along with their single components. Subgroup analysis for freedom from NACE and MACE was performed according to length of DAPT and clinical presentation [ST-elevation myocardial infarction (STEMI)-ACS versus non-ST-elevation myocardial infarction (NSTEMI)-ACS].

RESULTS
In total, 4424 patients (2725 ticagrelor, 1699 prasugrel) were enrolled. After propensity-score matching, 1290 patients in each cohort were included in the analysis. At 12 months, the incidence of both NACE and MACE was lower with prasugrel (NACE: 5.3% vs. 8.5% [p = 0.001]; MACE: 5% vs. 8.1% [p =  0.001]) mainly driven by a reduction in recurrent myocardial infarction (MI) (2.4 vs. 4.0%; p = 0.029) and a lower rate of Bleeding Academic Research Consortium (BARC) 3-5 bleeding (1.5 vs. 2.9%; p = 0.011). The benefit of prasugrel was confirmed for patients with NSTEMI and for those discharged with a DAPT regimen of ≤ 12 months. Only a trend in the reduction of NACE and MACE was noted for STEMI or for those treated with longer DAPT.

CONCLUSIONS
Comparison of these drugs suggested that prasugrel is safer and more efficacious than ticagrelor in combination with aspirin after NSTEMI but not STEMI. No differences were found for events occurring after 12 months. The nonrandomized design of the present research means further studies are required to support these findings.



AUTHOR(S)

Ovidio De Filippo, Martina Cortese, Fabrizio D Ascenzo, Sergio Raposeiras-Roubin, Emad Abu-Assi, Tim Kinnaird, Albert Ariza-Solé, Sergio Manzano-Fernández, Christian Templin, Lazar Velicki, Ioanna Xanthopoulou, Enrico Cerrato, Andrea Rognoni, Giacomo Boccuzzi, Antonio Montefusco, Andrea Montabone, Salma Taha, Alessandro Durante, Sebastiano Gili, Giulia Magnani, Michele Autelli, Alberto Grosso, Pedro Flores Blanco, Alberto Garay, Giorgio Quadri, Ferdinando Varbella, Berenice Caneiro Queija, Rafael Cobas Paz, María Cespón Fernández, Isabel Muñoz Pousa, Diego Gallo, Umberto Morbiducci, Alberto Dominguez-Rodriguez, Mariano Valdés, Angel Cequier, Dimitrios Alexopoulos, Andrés Iñiguez-Romo, Mauro Rinaldi,

JOURNAL

American journal of cardiovascular drugs : drugs, devices, and other interventions

PLACE

New Zealand