Prasugrel Versus Ticagrelor in Patients With Acute Myocardial
Infarction Treated With Primary Percutaneous Coronary
Intervention Multicenter Randomized PRAGUE-18 Study

J 2016

Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention Multicenter Randomized PRAGUE-18 Study

MOTOVSKA, Zuzana; Ota HLINOMAZ; Roman MIKLIK; Milan HROMADKA; Ivo VARVAROVSKY et al.

Základní údaje

Originální název

Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention Multicenter Randomized PRAGUE-18 Study

Autoři

Vydání

Circulation, Philadelphia, Lippincott Williams Wilkins, 2016, 0009-7322

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30201 Cardiac and Cardiovascular systems

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Impakt faktor

Impact factor: 19.309

Označené pro přenos do RIV

Ano

Kód RIV

RIV/00216224:14110/16:00093173

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

myocardial infarction; percutaneous coronary intervention; prasugrel hydrochloride; safety; ticagrelor; treatment outcome

Štítky

EL OK

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 13. 3. 2018 10:38, Soňa Böhmová

Anotace

V originále

BACKGROUND: No randomized head-to-head comparison of the efficacy and safety of ticagrelor and prasugrel has been published in the 7 years since the higher efficacy of these newer P2Y(12) inhibitors were first demonstrated relative to clopidogrel. METHODS: This academic study was designed to compare the efficacy and safety of prasugrel and ticagrelor in acute myocardial infarction treated with primary or immediate percutaneous coronary intervention. A total of 1230 patients were randomly assigned across 14 sites to either prasugrel or ticagrelor, which was initiated before percutaneous coronary intervention. Nearly 4% were in cardiogenic shock, and 5.2% were on mechanical ventilation. The primary end point was defined as death, reinfarction, urgent target vessel revascularization, stroke, or serious bleeding requiring transfusion or prolonging hospitalization at 7 days (to reflect primarily the in-hospital phase). This analysis presents data from the first 30 days (key secondary end point). The total follow-up will be 1 year for all patients and will be completed in 2017. RESULTS: The study was prematurely terminated for futility. The occurrence of the primary end point did not differ between groups receiving prasugrel and ticagrelor (4.0% and 4.1%, respectively; odds ratio, 0.98; 95% confidence interval, 0.55-1.73; P=0.939). No significant difference was found in any of the components of the primary end point. The occurrence of key secondary end point within 30 days, composed of cardiovascular death, nonfatal myocardial infarction, or stroke, did not show any significant difference between prasugrel and ticagrelor (2.7% and 2.5%, respectively; odds ratio, 1.06; 95% confidence interval, 0.53-2.15; P=0.864). CONCLUSIONS: This head-to-head comparison of prasugrel and ticagrelor does not support the hypothesis that one is more effective or safer than the other in preventing ischemic and bleeding events in the acute phase of myocardial infarction treated with a primary percutaneous coronary intervention strategy. The observed rates of major outcomes were similar but with broad confidence intervals around the estimates. These interesting observations need to be confirmed in a larger trial.

Citovat

MOTOVSKA, Zuzana; Ota HLINOMAZ; Roman MIKLIK; Milan HROMADKA; Ivo VARVAROVSKY; Jaroslav DUSEK; Jiri KNOT; Jiří JARKOVSKÝ; Petr KALA; Richard ROKYTA; Frantisek TOUSEK; Petra KRAMÁRIKOVÁ; Bohumil MAJTAN; Stanislav SIMEK; Marian BRANNY; Jan MROZEK; Pavel CERVINKA; Jiri OSTRANSKY a Petr WIDIMSKY. Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention Multicenter Randomized PRAGUE-18 Study. Circulation. Philadelphia: Lippincott Williams Wilkins, 2016, roč. 134, č. 21, s. "1603"-"+", 37 s. ISSN 0009-7322. Dostupné z: https://doi.org/10.1161/CIRCULATIONAHA.116.024823.

@article{1369489,
   author = {Motovska, Zuzana and Hlinomaz, Ota and Miklik, Roman and Hromadka, Milan and Varvarovsky, Ivo and Dusek, Jaroslav and Knot, Jiri and Jarkovský, Jiří and Kala, Petr and Rokyta, Richard and Tousek, Frantisek and Kramáriková, Petra and Majtan, Bohumil and Simek, Stanislav and Branny, Marian and Mrozek, Jan and Cervinka, Pavel and Ostransky, Jiri and Widimsky, Petr},
   article_location = {Philadelphia},
   article_number = {21},
   doi = {https://doi.org/10.1161/CIRCULATIONAHA.116.024823},
   keywords = {myocardial infarction; percutaneous coronary intervention; prasugrel hydrochloride; safety; ticagrelor; treatment outcome},
   language = {eng},
   issn = {0009-7322},
   journal = {Circulation},
   title = {Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention Multicenter Randomized PRAGUE-18 Study},
   volume = {134},
   year = {2016}
}

TY  - JOUR
ID  - 1369489
AU  - Motovska, Zuzana - Hlinomaz, Ota - Miklik, Roman - Hromadka, Milan - Varvarovsky, Ivo - Dusek, Jaroslav - Knot, Jiri - Jarkovský, Jiří - Kala, Petr - Rokyta, Richard - Tousek, Frantisek - Kramáriková, Petra - Majtan, Bohumil - Simek, Stanislav - Branny, Marian - Mrozek, Jan - Cervinka, Pavel - Ostransky, Jiri - Widimsky, Petr
PY  - 2016
TI  - Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention Multicenter Randomized PRAGUE-18 Study
JF  - Circulation
VL  - 134
IS  - 21
SP  - "1603"-"+"
EP  - "1603"-"+"
PB  - Lippincott Williams Wilkins
SN  - 00097322
KW  - myocardial infarction
KW  - percutaneous coronary intervention
KW  - prasugrel hydrochloride
KW  - safety
KW  - ticagrelor
KW  - treatment outcome
N2  - BACKGROUND: No randomized head-to-head comparison of the efficacy and safety of ticagrelor and prasugrel has been published in the 7 years since the higher efficacy of these newer P2Y(12) inhibitors were first demonstrated relative to clopidogrel. METHODS: This academic study was designed to compare the efficacy and safety of prasugrel and ticagrelor in acute myocardial infarction treated with primary or immediate percutaneous coronary intervention. A total of 1230 patients were randomly assigned across 14 sites to either prasugrel or ticagrelor, which was initiated before percutaneous coronary intervention. Nearly 4% were in cardiogenic shock, and 5.2% were on mechanical ventilation. The primary end point was defined as death, reinfarction, urgent target vessel revascularization, stroke, or serious bleeding requiring transfusion or prolonging hospitalization at 7 days (to reflect primarily the in-hospital phase). This analysis presents data from the first 30 days (key secondary end point). The total follow-up will be 1 year for all patients and will be completed in 2017. RESULTS: The study was prematurely terminated for futility. The occurrence of the primary end point did not differ between groups receiving prasugrel and ticagrelor (4.0% and 4.1%, respectively; odds ratio, 0.98; 95% confidence interval, 0.55-1.73; P=0.939). No significant difference was found in any of the components of the primary end point. The occurrence of key secondary end point within 30 days, composed of cardiovascular death, nonfatal myocardial infarction, or stroke, did not show any significant difference between prasugrel and ticagrelor (2.7% and 2.5%, respectively; odds ratio, 1.06; 95% confidence interval, 0.53-2.15; P=0.864). CONCLUSIONS: This head-to-head comparison of prasugrel and ticagrelor does not support the hypothesis that one is more effective or safer than the other in preventing ischemic and bleeding events in the acute phase of myocardial infarction treated with a primary percutaneous coronary intervention strategy. The observed rates of major outcomes were similar but with broad confidence intervals around the estimates. These interesting observations need to be confirmed in a larger trial.
ER  -

MOTOVSKA, Zuzana; Ota HLINOMAZ; Roman MIKLIK; Milan HROMADKA; Ivo VARVAROVSKY; Jaroslav DUSEK; Jiri KNOT; Jiří JARKOVSKÝ; Petr KALA; Richard ROKYTA; Frantisek TOUSEK; Petra KRAMÁRIKOVÁ; Bohumil MAJTAN; Stanislav SIMEK; Marian BRANNY; Jan MROZEK; Pavel CERVINKA; Jiri OSTRANSKY a Petr WIDIMSKY. Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention Multicenter Randomized PRAGUE-18 Study. \textit{Circulation}. Philadelphia: Lippincott Williams Wilkins, 2016, roč.~134, č.~21, s.~''1603''-''+'', 37 s. ISSN~0009-7322. Dostupné z: https://doi.org/10.1161/CIRCULATIONAHA.116.024823.

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