Ticagrelor or prasugrel in patients with acute coronary syndromes
Open accessAbstract
BACKGROUND: The relative merits of ticagrelor as compared with prasugrel in patients with acute coronary syndromes for whom invasive evaluation is planned are uncertain. METHODS: In this multicenter, randomized, open-label trial, we randomly assigned patients who presented with acute coronary syndromes and for whom invasive evaluation was planned to receive either ticagrelor or prasugrel. The primary end point was the composite of death, myocardial infarction, or stroke at 1 year. A major secondary end point (the safety end point) was bleeding. RESULTS: A total of 4018 patients underwent randomization. A primary end-point event occurred in 184 of 2012 patients (9.3%) in the ticagrelor group and in 137 of 2006 patients (6.9%) in the prasugrel group (hazard ratio, 1.36; 95% confidence interval [CI], 1.09 to 1.70; P = 0.006). The respective incidences of the individual components of the primary end point in the ticagrelor group and the prasugrel group were as follows: death, 4.5% and 3.7%; myocardial infarction, 4.8% and 3.0%; and stroke, 1.1% and 1.0%. Definite or probable stent thrombosis occurred in 1.3% of patients assigned to ticagrelor and 1.0% of patients assigned to prasugrel, and definite stent thrombosis occurred in 1.1% and 0.6%, respectively. Major bleeding (as defined by the Bleeding Academic Research Consortium scale) was observed in 5.4% of patients in the ticagrelor group and in 4.8% of patients in the prasugrel group (hazard ratio, 1.12; 95% CI, 0.83 to 1.51; P = 0.46). CONCLUSIONS: Among patients who presented with acute coronary syndromes with or without ST-segment elevation, the incidence of death, myocardial infarction, or stroke was significantly lower among those who received prasugrel than among those who received ticagrelor, and the incidence of major bleeding was not significantly different between the two groups. (Funded by the German Center for Cardiovascular Research and Deutsches Herzzentrum München; ISAR-REACT 5 ClinicalTrials.gov number, NCT01944800.).
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The open-label ISAR-REACT 5 trial randomized 4018 patients with acute coronary syndrome to prasugrel or ticagrelor added to acetylsalicylic acid.
“The open-label ISAR-REACT 5 (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment) trial randomized 4018 patients with ACS to prasugrel or ticagrelor added to ASA.”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [313]
Prasugrel was superior to ticagrelor in reducing MACE without increasing major bleeding, with similar effects in the sub-group of patients with diabetes (n = 892; 22%).
“Prasugrel was superior to ticagrelor in reducing MACE without increasing major bleeding, with similar effects in the sub-group of patients with diabetes (n = 892; 22%; Supplementary data online, Table S12).313”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [313]
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2021 ESC Guidelines on cardiovascular disease prevention in clinical practice
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Self-citation2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes.
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- Authors
- Schüpke, S., Neumann, F.-J., Menichelli, M., Mayer, K., Bernlochner, I., Wöhrle, J., Richardt, G., Liebetrau, C., Witzenbichler, B., Antoniucci, D., Akin, I., Bott-Flügel, L., Fischer, M., Landmesser, U., Katus, H. A., Sibbing, D., Seyfarth, M., Janisch, M., Boncompagni, D., Hilz, R., Rottbauer, W., Okrojek, R., Möllmann, H., Hochholzer, W., Migliorini, A., Cassese, S., Mollo, P., Xhepa, E., Kufner, S., Strehle, A., Leggewie, S., Allali, A., Ndrepepa, G., Schühlen, H., Angiolillo, D. J., Hamm, C. W., Hapfelmeier, A., Tölg, R., Trenk, D., Schunkert, H., Laugwitz, K.-L., & Kastrati, A.
- Affiliations
- German Centre for Cardiovascular Research (DE)
- From the Department of Cardiology, Deutsches Herzzentrum München, and Technische Universität München (S.S., K.M., M.J., R.H., S.C., E.X., S.K., G.N., H. Schunkert, A.K.), the German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance (S.S., D.S., H. Schunkert, K.-L.L., A.K.), the Department of Cardiology, Angiology, and Pulmonology, Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar (I.B., R.O., K.-L.L.), the Department of Cardiology, Klinikum der Universität...
- ORCID
- Schüpke, Stefanie
- Neumann, Franz-Josef
- Mayer, Katharina
- Bernlochner, Isabell
- Wöhrle, Jochen
- Liebetrau, Christoph
- Witzenbichler, Bernhard
- Fischer, Marcus
- Landmesser, Ulf
- Katus, Hugo A.
- Sibbing, Dirk
- Seyfarth, Melchior
- Janisch, Marion
- Möllmann, Helge
- Cassese, Salvatore
- Xhepa, Erion
- Kufner, Sebastian
- Allali, Abdelhakim
- Ndrepepa, Gjin
- Schühlen, Helmut
- Angiolillo, Dominick J.
- Hamm, Christian W.
- Hapfelmeier, Alexander
- Trenk, Dietmar
- Schunkert, Heribert
- Laugwitz, Karl-Ludwig
- Kastrati, Adnan
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2019-10-17
- Volume
- 381
- Issue
- 16
- Pages
- 1524-1534
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2971165578
- Cited by
- 816
- References
- 20
- Citations by year
- 2026: 72 · 2025: 82 · 2024: 69 · 2023: 97 · 2022: 123 · 2021: 174 · 2020: 158 · 2019: 39 · 2013: 1
- FWCI
- 89.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- University of Regensburg Publication Server (University of Regensburg) (submittedVersion)
- mediaTUM (Technical University of Munich) (submittedVersion)
- Funders
- German Center for Cardiovascular Research, Deutsches Herzzentrum München (FKZ 81X1600501)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- ticagrelor, prasugrel, acute coronary syndrome, P2Y12 inhibitors, antiplatelet therapy, major bleeding, stent thrombosis, myocardial infarction, stroke, mortality, invasive coronary angiography, ST-elevation myocardial infarction, bleeding risk stratification, bleeding risk prediction model
- MeSH terms
- Prasugrel Hydrochloride, Ticagrelor, Aged, Coronary Thrombosis, Female, Hemorrhage, Humans, Male, Middle Aged, Myocardial Infarction, Platelet Aggregation Inhibitors, Stents, Incidence, Stroke, Kaplan-Meier Estimate, Acute Coronary Syndrome, Purinergic P2Y Receptor Antagonists, Percutaneous Coronary Intervention
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