1. Ticagrelor or Prasugrel in Patients With Acute Coronary Syndrome in Relation to Estimated Glomerular Filtration Rate
- Author
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Franz-Josef Neumann, Dirk Sibbing, Christian M. Valina, Hendrik B. Sager, Jochen Wöhrle, Karl-Ludwig Laugwitz, Rayyan Hemetsberger, Alexander Hapfelmeier, Sebastian Kufner, Dominick J. Angiolillo, Erion Xhepa, Senta Gewalt, Gjin Ndrepepa, Katharina Mayer, Maurizio Menichelli, Stefanie Schüpke, Gert Richardt, Michael Joner, Julia Seeger, Shqipdona Lahu, Bernhard Witzenbichler, Willibald Hochholzer, Salvatore Cassese, Adnan Kastrati, Isabell Bernlochner, and Heribert Schunkert
- Subjects
Ticagrelor ,Acute coronary syndrome ,medicine.medical_specialty ,Prasugrel ,medicine.medical_treatment ,Renal function ,law.invention ,Percutaneous Coronary Intervention ,Randomized controlled trial ,law ,Internal medicine ,Clinical endpoint ,Humans ,Medicine ,In patient ,Prospective Studies ,Acute Coronary Syndrome ,business.industry ,Percutaneous coronary intervention ,medicine.disease ,Treatment Outcome ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Prasugrel Hydrochloride ,Platelet Aggregation Inhibitors ,Glomerular Filtration Rate ,medicine.drug - 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 ( 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 )
- Published
- 2021