Abstract 15391: Five-Year Outcomes in Patients With Acute Coronary Syndrome and Myocardial Revascularization Treated With Prasugrel or Ticagrelor

Abstract

Background: In patients with acute coronary syndrome (ACS) treated with coronary intervention, potent P2Y12 inhibitors are recommended for 1 year in addition to aspirin. The ISAR-REACT 5 (IR5) trial demonstrated superior efficacy of prasugrel over ticagrelor in reducing the composite of death, myocardial infarction (MI), and stroke at 1 year with comparable bleeding risk. However, long-term data on the relative efficacy of these drugs in real-world settings are lacking. Methods: We performed a comprehensive, retrospective cohort study based on German health insurance data. Patients with ACS who underwent percutaneous coronary intervention or coronary artery bypass graft surgery and received either prasugrel or ticagrelor were observed for 5 years. For 36,813 eligible patients, 1:1 propensity score matching was performed based on age, sex, risk factors and type of ACS. Primary endpoint was a composite of death, MI, or stroke. Safety outcome was bleeding. Results: After matching, 26,494 patients were included in the study. Mean age was 61.8 years, and 25,3% were female. The risk for the primary endpoint was lower in the prasugrel group compared with ticagrelor at 1 year (hazard ratio (HR): 0.79; 95% confidence interval (CI): 0,73-0.87), and 5 years (HR: 0.84; 95% CI: 0.79-0.89). Prasugrel was statistically superior in reducing individual components of the primary endpoint at 1 and 5 years, respectively. The risk of bleeding was lower in the prasugrel group, though not statistically significant. Conclusions: In patients with ACS, prasugrel was associated with a lower risk of the composite of death, MI or stroke, compared with ticagrelor over a 5-year period. While recognizing the limitations associated with secondary data, the strength of these findings lies in the extensive follow-up period involving a large ACS cohort in a real-world setting. The consistency of these results with the IR5 trial reinforces prasugrel's superiority over ticagrelor.