Author + information
- Jumin Won1,
- Min Chul Kim1,
- Myung Ho Jeong1,
- Young Joon Hong1,
- Doo Sun Sim1,
- Youngkeun Ahn2,
- Tae Hoon Ahn3,
- Seung Ki-Bae4,
- Dong Joo Oh5,
- Hyo-Soo Kim6,
- Hyeon Cheol Gwon7,
- In Whan Seong8,
- Young Jo Kim9,
- Seok-Kyu Oh10 and
- Jei Keon Chae11
- 1Chonnam National University Hospital, Gwangju, Korea, Republic of
- 2Chonnam National Univ Hosp, Gwangju, Kuwait
- 3Gachon University Gil Medical Center, Incheon, Korea, Republic of
- 4Catholic University Hospital, Seoul, Korea, Republic of
- 5Korea university Guro Hospital, Seoul, Korea, Republic of
- 6Seoul National University Hospital, Seoul, Korea, Republic of
- 7Samsung Medical Center, Seoul, Korea, Republic of
- 8Chungnam National University Hospital, Daejeon, Korea, Republic of
- 9Yeungnam university hospital, Daegu, Korea, Republic of
- 10Wonkwang University School of Medicine, Iksan, Korea, Republic of
- 11Chonbuk National University Hospital, Jeonju, Korea, Republic of
Although new ADP-receptor antagonist such as prasugrel or ticagrelor has been known to improve clinical outcomes in patients with acute coronary syndrome, there are few studies which compared prasugrel and ticagrelor in patients with ST-segment elevation myocardial infarction (STEMI). Moreover, their safety profiles as well as clinical impacts were not well studied in Asian patients.
Between November 2011 and October 2015, a total of 1440 patients with STEMI who underwent successful primary percutaneous coronary intervention (PCI) were analyzed from the Korea Acute Myocardial Infarction Registry-National Institute of Health (ticagrelor 963 and prasugrel 477 patients). We did not include patients who discontinued or switched antiplatelet medications during admission. Primary study outcome was major adverse cardiac outcomes (MACE: the composite of cardiac death, MI, stroke or target-vessel revascularization [TVR]) during 1-year follow-up (median 353 days [interquartile range 190-378]). We also analyzed the incidence of all-cause mortality, cardiac mortality, MI, stroke, TVR, definite or probable stent thrombosis and in-hospital outcomes including in-hospital bleeding events (TIMI major or minor bleeding).
Ticagrelor group was more elderly (61.7 vs. 55.9 years, p <0.001) and had more female patients (19.5 vs. 9.0%, p <0.001). Although prevalence of hypertension, history of cerebrovascular disease and MI were higher in ticagrelor group, other atherosclerotic risk factors were similarly prevalent between 2 groups. During PCI, prasugrel group more received transfemoral approach (66.0 vs. 75.9%, p <0.001), and thrombi aspiration or glycoprotein IIb/IIIa inhibitor were similarly used during procedure. MACE occurred in 73 patients (5.1%) during 1-year follow-up. There were no differences in incidence of MACE (5.3 vs. 4.6%, p = 0.612), all-cause death (3.5 vs. 3.1%, p = 0.760), cardiac death (2.5 vs. 2.9%, p = 0.605), MI (0.9 vs. 0.8%, p = 0.856), TVR (1.6 vs. 0.8%, p = 0.331), stroke (0.8 vs. 0.2%, p = 0.286), stent thrombosis (0.7 vs. 0.8%, p = 0.759) or in-hospital bleeding events (4.3 vs 6.7%, p = 0.055) between two groups. Analysis by propensity score matching (429 pairs) did not significantly affect the results. The incidence of in-hospital bleeding events was still comparable between two groups (4.2 vs. 6.8%, p = 0.133) and there were also no significant difference in incidence of MACE (3.5 vs. 4.9%, hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.41-1.54, p = 0.490), all-cause death (2.6 vs. 3.3%, HR 0.83, 95% CI 0.38-1.84, p = 0.650), cardiac death (1.6 vs. 3.0%, HR 0.56, 95% CI 0.23-1.41, p = 0.221), MI (0.7 vs. 0.9%, HR 0.76, 95% CI 0.17-3.51, p = 0.729), TVR (1.4 vs. 0.9%, HR 1.38, 95% CI 0.37-5.09, p = 0.630), stroke (0.2 vs. 0.2%, HR 1.18, 95% CI 0.07-18.86, p = 0.907) and stent thrombosis (1.4 vs. 0.7%, HR 1.76, 95% CI 0.42-7.26, p = 0.437) after matching.
Ticagrelor and prasugrel showed similar efficacy and efficacy profiles for the treatment of STEMI in the Korean multicenter registry.
CORONARY: Acute Myocardial Infarction