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

Woehrle, Jochen; Seeger, Julia; Lahu, Shqipdona; Mayer, Katharina; Bernlochner, Isabell; Gewalt, Senta; Menichelli, Maurizio; Witzenbichler, Bernhard; Hochholzer, Willibald; Sibbing, Dirk; Cassese, Salvatore; Angiolillo, Dominick J.; Hemetsberger, Rayyan; Valina, Christian; Kufner, Sebastian; Xhepa, Erion; Hapfelmeier, Alexander; Sager, Hendrik B.; Joner, Michael; Richardt, Gert; Laugwitz, Karl-Ludwig; Neumann, Franz Josef; Schunkert, Heribert; Schuepke, Stefanie; Kastrati, Adnan und Ndrepepa, Gjin (2021): Ticagrelor or Prasugrel in Patients With Acute Coronary Syndrome in Relation to Estimated Glomerular Filtration Rate. In: Jacc-Cardiovascular Interventions, Bd. 14, Nr. 17: S. 1857-1866

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 m(2)), intermediate eGFR (>= 60 and <90 mL/min/1.73 m(2)), and high eGFR (>= 90 mL/min/1.73 m(2)). 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) (C) 2021 by the American College of Cardiology Foundation.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1936-8798
• Sprache: Englisch