Ticagrelor or Prasugrel in Patients With Acute Coronary Syndrome in Relation to Estimated Glomerular Filtration Rate

Woehrle J, Seeger J, Lahu S, Mayer K, Bernlochner I, Gewalt S, Menichelli M, Witzenbichler B, Hochholzer W, Sibbing D, Cassese S, Angiolillo DJ, Hemetsberger R, Valina C, Kufner S, Xhepa E, Hapfelmeier A, Sager HB, Joner M, Richardt G, Laugwitz KL, Neumann FJ, Schunkert H, Schuepke S, Kastrati A, Ndrepepa G (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Jacc-Cardiovascular Interventions Elsevier

Book Volume: 14

Pages Range: 1857-1866

Journal Issue: 17

DOI: 10.1016/j.jcin.2021.06.028

Abstract

Objectives: The aim of this study was to assess the safety and efficacy of ticagrelor versus prasugrel for patients with acute coronary syndrome (ACS) according to their estimated glomerular filtration rates (eGFRs). Background: The outcomes of ticagrelor versus prasugrel in patients with ACS according to eGFR have not been defined. Methods: Patients (n = 4,012) were categorized into 3 groups: low eGFR (<60 mL/min/1.73 m2), intermediate eGFR (≥60 and <90 mL/min/1.73 m2), and high eGFR (≥90 mL/min/1.73 m2). The primary endpoint was a composite of all-cause death, myocardial infarction, and stroke; the secondary safety endpoint was Bleeding Academic Research Consortium types 3 to 5 bleeding, both at 1 year. Results: Patients with low eGFRs had a higher risk for the primary endpoint compared with patients with intermediate eGFRs (adjusted HR: 1.89; 95% CI: 1.46-2.46]) and those with high eGFRs (adjusted HR: 2.33; 95% CI: 1.57-3.46). A risk excess for low eGFR was also observed for bleeding (adjusted HR: 1.55 [95% CI: 1.12-2.13] vs intermediate eGFR; adjusted HR: 1.59 [95% CI: 1.01-2.50] vs high eGFR). However, eGFR did not affect the relative efficacy and safety of ticagrelor versus prasugrel. In patients with low eGFR, the primary endpoint occurred in 20.5% with ticagrelor and in 14.7% with prasugrel (HR: 1.47; 95% CI: 1.04-2.08; P = 0.029); there was no significant difference in bleeding. Conclusions: These results show that among patients with ACS, reduction of eGFR is associated with increased risk for ischemic and bleeding events but has no significant impact on the relative efficacy and safety of ticagrelor versus prasugrel. (Prospective, Randomized Trial of Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome [ISAR-REACT 5]; NCT01944800)

Involved external institutions

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

How to cite

APA:

Woehrle, J., Seeger, J., Lahu, S., Mayer, K., Bernlochner, I., Gewalt, S.,... Ndrepepa, G. (2021). Ticagrelor or Prasugrel in Patients With Acute Coronary Syndrome in Relation to Estimated Glomerular Filtration Rate. Jacc-Cardiovascular Interventions, 14(17), 1857-1866. https://doi.org/10.1016/j.jcin.2021.06.028

MLA:

Woehrle, Jochen, et al. "Ticagrelor or Prasugrel in Patients With Acute Coronary Syndrome in Relation to Estimated Glomerular Filtration Rate." Jacc-Cardiovascular Interventions 14.17 (2021): 1857-1866.

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