Access Route and Clinical Outcomes After Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome Undergoing Invasive Treatment Strategy

Hemetsberger R, Richardt G, Lahu S, Valina C, Menichelli M, Abdelghani M, Wohrle J, Toelg R, Witzenbichler B, Mankerious N, Liebetrau C, Bernlochner I, Hamm CW, Allali A, Joner M, Fusaro M, Xhepa E, Hapfelmeier A, Kufner S, Sager HB, Schuepke S, Laugwitz KL, Schunkert H, Neumann FJ, Kastrati A, Cassese S (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Cardiovascular Revascularization Medicine Elsevier

Book Volume: 41

Pages Range: 122-128

DOI: 10.1016/j.carrev.2021.12.029

Abstract

Background: Whether the access site influences the comparative efficacy and safety of ticagrelor and prasugrel in patients with acute coronary syndrome (ACS) undergoing invasive treatment strategy remains unstudied. Methods: This post-hoc analysis included ACS patients undergoing invasive treatment via radial or femoral access and randomized to either ticagrelor or prasugrel in the ISAR-REACT 5 trial. The primary efficacy endpoint was the composite of death, myocardial infarction (MI) or stroke, safety endpoint was BARC 3 to 5 bleeding. Outcomes were assessed out to 12 months after randomization. Results: Out of 4018 patients, 3984 underwent invasive treatment via radial or femoral access. 1479 had coronary angiography via radial access (ticagrelor, N = 748; prasugrel, N = 731) and 2505 via femoral access (ticagrelor, N = 1245; prasugrel, N = 1260). There was no interaction between access route and assignment to either ticagrelor or prasugrel regarding the primary efficacy or safety endpoints (P for interaction≥0.616). In the radial group, the primary efficacy endpoint (7.6% versus 5.8%, HR: 1.32 [0.88–1.97], P = 0.151) and the safety endpoint (4.3% versus 3.0%, HR: 1.36, [0.73–1.31], P = 0.300) were not statistically different in patients receiving either ticagrelor or prasugrel. In the femoral group, the primary efficacy endpoint occurred more frequently in patients assigned to ticagrelor as compared to prasugrel (10.3% versus 7.3%, HR: 1.44 [1.10–1.88], P = 0.006) without significant difference in terms of safety endpoint (6.4% versus 5.8%, HR: 1.14, [0.81–1.60], P = 0.470). Conclusions: In patients with ACS undergoing an invasive treatment strategy, the access route does not influence the comparative efficacy and safety of ticagrelor and prasugrel. CLINICAL TRIAL REGISTRATION: NCT01944800

Involved external institutions

Segeberger Kliniken DE Germany (DE) Deutsches Herzzentrum München DE Germany (DE) Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH DE Germany (DE) Ospedale Fabrizio Spaziani IT Italy (IT) Al Azhar University EG Egypt (EG) Medizin Campus Bodensee DE Germany (DE) HELIOS Kliniken DE Germany (DE) Justus-Liebig-Universität Gießen DE Germany (DE) Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK e.V.) DE Germany (DE) Technische Universität München (TUM) DE Germany (DE) Klinikum rechts der Isar DE Germany (DE)

How to cite

APA:

Hemetsberger, R., Richardt, G., Lahu, S., Valina, C., Menichelli, M., Abdelghani, M.,... Cassese, S. (2022). Access Route and Clinical Outcomes After Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome Undergoing Invasive Treatment Strategy. Cardiovascular Revascularization Medicine, 41, 122-128. https://dx.doi.org/10.1016/j.carrev.2021.12.029

MLA:

Hemetsberger, Rayyan, et al. "Access Route and Clinical Outcomes After Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome Undergoing Invasive Treatment Strategy." Cardiovascular Revascularization Medicine 41 (2022): 122-128.

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