Prasugrel versus ticagrelor in ST-elevation myocardial infarction, a real-world cohort

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction ST-elevation myocardial infarction (STEMI) requires starting dual antiplatelet therapy as soon as possible. Potent P2Y12 inhibitors (prasugrel and ticagrelor) are preferred over clopidogrel. However, real world data is scarce when comparing potent P2Y12 inhibitors. Purpose To compare in-hospital clinical outcome between patients presenting with STEMI and treated either with prasugrel or ticagrelor. Methods Observational retrospective study of consecutive patients with STEMI admitted to the Cardiac Intensive Care Unit (CICU) between July 2011 and September 2022. Baseline characteristics and clinical outcome were compared between prasugrel and ticagrelor. Results 1100 patients were gathered in this period. 417 of them were treated with prasugrel and 683 with ticagrelor, at medical discretion. Patients in the prasugrel group were younger (56±9 vs 61±12), predominantly male (86% vs 75%) and more commonly current smokers (60% vs 48%). The rest of baseline characteristics are shown in Table 1. We performed several multivariate logistic regression analysis to evaluate in-hospital efficacy and safety of these drugs. Prasugrel showed a lower non-adjusted in-hospital mortality over ticagrelor, that became not statistically significant after adjustment by baseline characteristics (Table 2). No significant differences were found between prasugrel and ticagrelor in respect of bleeding, which was associated with age and Killip-Kimball score. Conclusion In this real-world cohort, prasugrel showed a trend towards lower in-hospital mortality after adjusting for baseline characteristics. No differences in clinical bleeding were found.