Safety and Efficacy in Prasugrel- Versus Ticagrelor-Treated Patients With ST-Elevation Myocardial Infarction

Abstract

Prasugrel and ticagrelor are recommended over clopidogrel in patients with ST-elevation myocardial infarction (STEMI). In this registry analysis, we compared efficacy and safety of ticagrelor and prasugrel P2Y12 inhibition in patients with STEMI. We included 318 patients in this single-center analysis. Twelve-month follow-up was conducted during ambulatory care at our department. Patients were on dual antiplatelet therapy with aspirin and ticagrelor or prasugrel during the follow-up period. Prescription of prasugrel or ticagrelor, respectively, was according to the preference of the treating physician. Major adverse cardiac and cerebrovascular events (MACCE) [death, myocardial infarction (MI), stroke, and unplanned reintervention] and thrombolysis in myocardial infarction (TIMI) bleeding (major/minor) were registered during hospitalization and follow-up. TIMI bleeding events were more frequent in ticagrelor-treated patients [17 vs. 5 patients, hazard ratio (HR) 2.85, 95% confidence interval (CI) 1.2-6.6; log-rank P value = 0.01]. Prasugrel-treated patients were significantly younger (ticagrelor 63 ± 12 years vs. prasugrel 57 ± 10; P < 0.0001). Besides that, patients' characteristics were similar in both groups. Multivariate analysis revealed that ticagrelor medication was independently associated with bleeding risk after adjustment for age, percutaneous coronary intervention approach (femoral vs. radial), diabetes mellitus, and kidney function (HR 3.01; 95% CI 1.0-7.4; P = 0.043). In patients treated with ticagrelor, 35 MACCE were detected. There was no difference as compared to prasugrel-treated patients (24 events, HR 1.24, 95% CI 0.79-2.09; log-rank P value = 0.41). TIMI bleeding events were more frequent in ticagrelor-treated patients with STEMI during 12-month follow-up. There were no differences in MACCE between groups in this registry analysis.

Efficacy and Safety of Ticagrelor in Diabetes Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

“…Previous studies pointed that ticagrelor may induce enhanced bleeding compared with clopidogrel 14 and prasugrel. 38 However, there was no significant difference in the number of bleeding events between the ticagrelor and control groups in our study. In the subgroup analysis, heterogeneity was present between the ticagrelor and clopidogrel groups.…”

The Relevance of MicroRNAs in the Pathogenesis and Prognosis of HCV-Disease: The Emergent Role of miR-17-92 in Cryoglobulinemic Vasculitis

“…HCV is responsible for 140,000 new cases of hepatocellular carcinoma (HCC), which is the primary liver cancer [28]. The importance of an early diagnosis has been demonstrated to improve the survival of HCC patients [29][30][31][32] even though, at present, the HCC guidelines report imaging-based diagnosis as the only option [33,34].…”

Overexpression of microRNA‐23a‐5p induces myocardial infarction by promoting cardiomyocyte apoptosis through inhibited of PI3K/AKT signalling pathway

“…Moreover, MI‐mediated myocardial capillary flow reserve, a loss of capillary density and impaired tissue perfusion would augment cellular injury and scar formation. At present, the treatments of MI are limited to anti‐fibrosis, early reperfusion, anticoagulation, thrombolytic therapy and arterial bypass surgery 3 . Although these therapies can effectively resume coronary blood flow, their ability to repair myocardial damage is not satisfying.…”

“…thrombolytic therapy and arterial bypass surgery. 3 Although these therapies can effectively resume coronary blood flow, their ability to repair myocardial damage is not satisfying. Thus, it is considered that a better understanding of MI pathogenesis can help with its diagnosis and treatment.…”