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Open Access 13-05-2024 | Ticagrelor | Original Paper

Incidence and pattern of urgent revascularization in acute coronary syndromes treated with ticagrelor or prasugrel

Authors: Alp Aytekin, Maria Scalamogna, J. J. Coughlan, Shqipdona Lahu, Gjin Ndrepepa, Maurizio Menichelli, Katharina Mayer, Jochen Wöhrle, Isabell Bernlochner, Bernhard Witzenbichler, Willibald Hochholzer, Dirk Sibbing, Dominick J. Angiolillo, Rayyan Hemetsberger, Ralph Tölg, Christian Valina, Arne Müller, Sebastian Kufner, Christoph Liebetrau, Erion Xhepa, Alexander Hapfelmeier, Hendrik B. Sager, Michael Joner, Gert Richardt, Karl-Ludwig Laugwitz, Franz Josef Neumann, Heribert Schunkert, Stefanie Schüpke, Adnan Kastrati, Salvatore Cassese

Published in: Clinical Research in Cardiology

Abstract

Background

The ISAR-REACT 5 trial compared the efficacy and safety of ticagrelor and prasugrel in patients with ACS managed invasively. The present study sought to investigate the impact of ticagrelor and prasugrel on the incidence and pattern of urgent revascularization in acute coronary syndromes (ACS) patients undergoing percutaneous coronary intervention (PCI).

Methods and results

This post-hoc analysis of the ISAR-REACT 5 trial included all ACS patients who underwent PCI. The primary endpoint for this analysis was the incidence of urgent revascularization at 12-month follow-up. Secondary outcome was the pattern of urgent revascularization procedures (namely, urgent target vessel/non-target vessel revascularization – TVR/NTVR). Among 3,377 ACS patients who underwent PCI, 1,676 were assigned to ticagrelor and 1,701 to prasugrel before PCI. After 12 months, the incidence of urgent revascularization was higher among patients assigned to ticagrelor as compared to prasugrel (6.8% vs. 5.2%; hazard ratio [HR] = 1.32, 95% confidence interval [CI] 1.00–1.75; p = 0.051), mostly attributable to significantly more urgent NTVR in the ticagrelor group (3.8% vs. 2.4%; HR = 1.62 [1.09–2.41]; p = 0.017). The risk of urgent TVR did not differ between treatment groups (3.3% vs. 3.0%; HR = 1.13 [0.77–1.65]; p = 0.546).

Conclusions

In ACS patients treated with PCI, the cumulative rate of urgent revascularizations after 12 months is higher with ticagrelor compared to prasugrel, due to a significant increase in urgent revascularizations involving remote coronary vessels.

Graphic abstract

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Title: Incidence and pattern of urgent revascularization in acute coronary syndromes treated with ticagrelor or prasugrel
Authors: Alp Aytekin
Maria Scalamogna
J. J. Coughlan
Shqipdona Lahu
Gjin Ndrepepa
Maurizio Menichelli
Katharina Mayer
Jochen Wöhrle
Isabell Bernlochner
Bernhard Witzenbichler
Willibald Hochholzer
Dirk Sibbing
Dominick J. Angiolillo
Rayyan Hemetsberger
Ralph Tölg
Christian Valina
Arne Müller
Sebastian Kufner
Christoph Liebetrau
Erion Xhepa
Alexander Hapfelmeier
Hendrik B. Sager
Michael Joner
Gert Richardt
Karl-Ludwig Laugwitz
Franz Josef Neumann
Heribert Schunkert
Stefanie Schüpke
Adnan Kastrati
Salvatore Cassese
Publication date: 13-05-2024
Publisher: Springer Berlin Heidelberg
Keywords: Ticagrelor
Prasugrel
Acute Coronary Syndrome
Published in: Clinical Research in Cardiology
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-024-02454-x

2024 ASCO Annual Meeting

Springer Medicine

Incidence and pattern of urgent revascularization in acute coronary syndromes treated with ticagrelor or prasugrel

Abstract

Background

Methods and results

Conclusions

Graphic abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods and results

Conclusions

Graphic abstract

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