Prasugrel Bests Ticagrelor in Acute Coronary Syndrome Care

Researchers used data from a German insurance claims database between January 2012 and December 2021 to emulate the ISAR-REACT5 trial within routine care settings.
They included 17,642 propensity score–matched adults (mean age, 63.1 years; 26.1% women) who were discharged after an invasive treatment strategy for acute coronary syndrome and received either ticagrelor (n = 8821) or prasugrel (n = 8821) in an outpatient setting.
The types of coronary syndromes included STEMI, non-STEMI, and unstable angina (n = 9793, 6558, and 1291, respectively); 98.5% patients underwent percutaneous coronary intervention.
The primary endpoint was the composite of all-cause mortality, MI, or stroke within 1 year of initiation of outpatient treatment with either of the two medications.
The secondary endpoints included the individual components of the primary endpoint along with stent thrombosis; major bleeding was included as the safety endpoint.

At the 1-year follow-up mark, individuals receiving ticagrelor showed a higher risk for the primary composite endpoint than those receiving prasugrel (hazard ratio [HR], 1.24; 95% CI, 1.12-1.37).
Compared with prasugrel, ticagrelor was associated with higher incidences of both MI (HR, 1.20; 95% CI, 1.06-1.36) and stroke (HR, 1.33; 95% CI, 1.02-1.74) but not all-cause mortality.
No significant differences in stent thrombosis and major bleeding risk were observed between the two treatment groups.
In the STEMI subgroup, prasugrel was associated with the primary composite end point in a smaller proportion of patients than ticagrelor (6.8% vs 9.3%); however, in the non-STEMI and unstable angina subgroups, both drugs showed comparable efficacy.

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