Ticagrelor or prasugrel in patients with acute coronary syndrome with off-hour versus on-hour presentation: a subgroup analysis of the ISAR-REACT 5 trial

Behnes M, Lahu S, Ndrepepa G, Menichelli M, Mayer K, Woehrle J, Bernlochner I, Gewalt S, Witzenbichler B, Hochholzer W, Sibbing D, Cassese S, Angiolillo DJ, Hemetsberger R, Valina C, Mueller A, Kufner S, Hamm CW, Xhepa E, Hapfelmeier A, Sager HB, Joner M, Fusaro M, Richardt G, Laugwitz KL, Neumann FJ, Schunkert H, Schupke S, Kastrati A, Akin I (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Clinical Research in Cardiology Springer Verlag (Germany)

DOI: 10.1007/s00392-022-02040-z

Abstract

Objectives: To assess the efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndrome (ACS) presenting during off- and on-hours. Background: The efficacy and safety of ticagrelor versus prasugrel in patients with ACS according to time of hospital presentation remain unknown. Methods: This post hoc analysis of the ISAR-REACT 5 trial included 1565 patients with ACS presenting off-hours and 2453 patients presenting on-hours, randomized to ticagrelor or prasugrel. The primary endpoint was a composite of death, myocardial infarction, or stroke; the safety endpoint was Bleeding Academic Research Consortium (BARC) type 3–5 bleeding, both at 12 months. Results: The primary endpoint occurred in 80 patients (10.4%) in the ticagrelor group and 57 patients (7.3%) in the prasugrel group in patients presenting off-hours (hazard ratio [HR] = 1.45; 95% confidence interval [CI] 1.03–2.03; P = 0.033), and 104 patients (8.5%) in the ticagrelor group and 80 patients (6.7%) in the prasugrel group in patients presenting on-hours (HR = 1.29 [0.97–1.73]; P = 0.085), without significant treatment arm-by-presentation time interaction (Pint = 0.62). BARC type 3 to 5 bleeding occurred in 35 patients (5.1%) in the ticagrelor group and 37 patients (5.3%) in the prasugrel group (P = 0.84) in patients presenting off-hours, and 60 patients (5.9%) in the ticagrelor group and 43 patients (4.6%) in the prasugrel group in patients presenting on-hours (P = 0.17). Conclusions: In patients with ACS planned to undergo an invasive treatment strategy, time of presentation (off-hours vs. on-hours) does not interact significantly with the relative efficacy and safety of ticagrelor vs. prasugrel. Clinical trial registration.: NCT01944800. Graphical abstract: [Figure not available: see fulltext.]

Involved external institutions

Ruprecht-Karls-Universität Heidelberg DE Germany (DE) Technische Universität München (TUM) DE Germany (DE) Ospedale Fabrizio Spaziani IT Italy (IT) Medizin Campus Bodensee DE Germany (DE) Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK e.V.) DE Germany (DE) HELIOS Kliniken DE Germany (DE) Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH DE Germany (DE) University of Florida US United States (USA) (US) Segeberger Kliniken DE Germany (DE) Justus-Liebig-Universität Gießen DE Germany (DE)

How to cite

APA:

Behnes, M., Lahu, S., Ndrepepa, G., Menichelli, M., Mayer, K., Woehrle, J.,... Akin, I. (2022). Ticagrelor or prasugrel in patients with acute coronary syndrome with off-hour versus on-hour presentation: a subgroup analysis of the ISAR-REACT 5 trial. Clinical Research in Cardiology. https://doi.org/10.1007/s00392-022-02040-z

MLA:

Behnes, Michael, et al. "Ticagrelor or prasugrel in patients with acute coronary syndrome with off-hour versus on-hour presentation: a subgroup analysis of the ISAR-REACT 5 trial." Clinical Research in Cardiology (2022).

BibTeX: Download