1-Year Outcomes of Patients Undergoing Primary Angioplasty for
Myocardial Infarction Treated With Prasugrel Versus Ticagrelor

J 2018

1-Year Outcomes of Patients Undergoing Primary Angioplasty for Myocardial Infarction Treated With Prasugrel Versus Ticagrelor

MOTOVSKA, Zuzana, Ota HLINOMAZ, Petr KALA, Milan HROMADKA, Jiri KNOT et. al.

Basic information

Original name

1-Year Outcomes of Patients Undergoing Primary Angioplasty for Myocardial Infarction Treated With Prasugrel Versus Ticagrelor

Authors

MOTOVSKA, Zuzana (203 Czech Republic, guarantor), Ota HLINOMAZ (203 Czech Republic, belonging to the institution), Petr KALA (203 Czech Republic, belonging to the institution), Milan HROMADKA (203 Czech Republic), Jiri KNOT (203 Czech Republic), Ivo VARVAROVSKY (203 Czech Republic), Jaroslav DUSEK (203 Czech Republic), Jiří JARKOVSKÝ (203 Czech Republic, belonging to the institution), Roman MIKLÍK (203 Czech Republic, belonging to the institution), Richard ROKYTA (203 Czech Republic), Frantisek TOUSEK (203 Czech Republic), Petra KRAMÁRIKOVÁ (203 Czech Republic, belonging to the institution), Michal SVOBODA (203 Czech Republic, belonging to the institution), Bohumil MAJTAN (203 Czech Republic), Stanislav SIMEK (203 Czech Republic), Marian BRANNY (203 Czech Republic), Jan MROZEK (203 Czech Republic), Pavel CERVINKA (203 Czech Republic), Jiri OSTRANSKY (203 Czech Republic) and Petr WIDIMSKY (203 Czech Republic)

Edition

Journal of the American College of Cardiology, New York, Elsevier Science INC, 2018, 0735-1097

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 18.639

RIV identification code

RIV/00216224:14110/18:00105203

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.jacc.2017.11.008

UT WoS

000423734100001

Keywords in English

myocardial infarction; outcome; prasugrel; primary percutaneous coronary intervention; switch; ticagrelor

Abstract

V originále

BACKGROUND Early outcomes of patients in the PRAGUE-18 (Comparison of Prasugrel and Ticagrelor in the Treatment of Acute Myocardial Infarction) study did not find any significant differences between 2 potent P2Y(12) inhibitors. OBJECTIVES The 1-year follow-up of the PRAGUE-18 study focused on: 1) a comparison of efficacy and safety between prasugrel and ticagrelor; and 2) the risk of major ischemic events related to an economically motivated post-discharge switch to clopidogrel. METHODS A total of 1,230 patients with acute myocardial infarction (MI) treated with primary percutaneous coronary intervention were randomized to prasugrel or ticagrelor with an intended treatment duration of 12 months. The combined endpoint was cardiovascular death, MI, or stroke at 1 year. Because patients had to cover the costs of study medication after hospital discharge, some patients decided to switch to clopidogrel. RESULTS The endpoint occurred in 6.6% of prasugrel patients and in 5.7% of ticagrelor patients (hazard ratio: 1.167; 95% confidence interval: 0.742 to 1.835; p = 0.503). No significant differences were found in: cardiovascular death (3.3% vs. 3.0%; p = 0.769), MI (3.0% vs. 2.5%; p = 0.611), stroke (1.1% vs. 0.7%; p = 0.423), all-cause death (4.7% vs. 4.2%; p = 0.654), definite stent thrombosis (1.1% vs. 1.5%; p = 0.535), all bleeding (10.9% vs. 11.1%; p = 0.999), and TIMI (Thrombolysis In Myocardial Infarction) major bleeding (0.9% vs. 0.7%; p = 0.754). The percentage of patients who switched to clopidogrel for economic reasons was 34.1% (n = 216) for prasugrel and 44.4% (n = 265) for ticagrelor (p = 0.003). Patients who were economically motivated to switch to clopidogrel had (compared with patients who continued the study medications) a lower risk of major cardiovascular events; however, they also had lower ischemic risk. CONCLUSIONS Prasugrel and ticagrelor are similarly effective during the first year after MI. Economically motivated early post-discharge switches to clopidogrel were not associated with an increased risk of ischemic events. (Comparison of Prasugrel and Ticagrelor in the Treatment of Acute Myocardial Infarction [PRAGUE-18]; NCT02808767) (c) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Links

LM2015090, research and development project

Name: Český národní uzel Evropské sítě infrastruktur klinického výzkumu (Acronym: CZECRIN)

Investor: Ministry of Education, Youth and Sports of the CR

Citovat

MOTOVSKA, Zuzana, Ota HLINOMAZ, Petr KALA, Milan HROMADKA, Jiri KNOT, Ivo VARVAROVSKY, Jaroslav DUSEK, Jiří JARKOVSKÝ, Roman MIKLÍK, Richard ROKYTA, Frantisek TOUSEK, Petra KRAMÁRIKOVÁ, Michal SVOBODA, Bohumil MAJTAN, Stanislav SIMEK, Marian BRANNY, Jan MROZEK, Pavel CERVINKA, Jiri OSTRANSKY and Petr WIDIMSKY. 1-Year Outcomes of Patients Undergoing Primary Angioplasty for Myocardial Infarction Treated With Prasugrel Versus Ticagrelor. Journal of the American College of Cardiology. New York: Elsevier Science INC, 2018, vol. 71, No 4, p. 371-381. ISSN 0735-1097. Available from: https://dx.doi.org/10.1016/j.jacc.2017.11.008.

@article{1482889,
   author = {Motovska, Zuzana and Hlinomaz, Ota and Kala, Petr and Hromadka, Milan and Knot, Jiri and Varvarovsky, Ivo and Dusek, Jaroslav and Jarkovský, Jiří and Miklík, Roman and Rokyta, Richard and Tousek, Frantisek and Kramáriková, Petra and Svoboda, Michal and Majtan, Bohumil and Simek, Stanislav and Branny, Marian and Mrozek, Jan and Cervinka, Pavel and Ostransky, Jiri and Widimsky, Petr},
   article_location = {New York},
   article_number = {4},
   doi = {http://dx.doi.org/10.1016/j.jacc.2017.11.008},
   keywords = {myocardial infarction; outcome; prasugrel; primary percutaneous coronary intervention; switch; ticagrelor},
   language = {eng},
   issn = {0735-1097},
   journal = {Journal of the American College of Cardiology},
   title = {1-Year Outcomes of Patients Undergoing Primary Angioplasty for Myocardial Infarction Treated With Prasugrel Versus Ticagrelor},
   url = {http://dx.doi.org/10.1016/j.jacc.2017.11.008},
   volume = {71},
   year = {2018}
}

TY  - JOUR
ID  - 1482889
AU  - Motovska, Zuzana - Hlinomaz, Ota - Kala, Petr - Hromadka, Milan - Knot, Jiri - Varvarovsky, Ivo - Dusek, Jaroslav - Jarkovský, Jiří - Miklík, Roman - Rokyta, Richard - Tousek, Frantisek - Kramáriková, Petra - Svoboda, Michal - Majtan, Bohumil - Simek, Stanislav - Branny, Marian - Mrozek, Jan - Cervinka, Pavel - Ostransky, Jiri - Widimsky, Petr
PY  - 2018
TI  - 1-Year Outcomes of Patients Undergoing Primary Angioplasty for Myocardial Infarction Treated With Prasugrel Versus Ticagrelor
JF  - Journal of the American College of Cardiology
VL  - 71
IS  - 4
SP  - 371-381
EP  - 371-381
PB  - Elsevier Science INC
SN  - 07351097
KW  - myocardial infarction
KW  - outcome
KW  - prasugrel
KW  - primary percutaneous coronary intervention
KW  - switch
KW  - ticagrelor
UR  - http://dx.doi.org/10.1016/j.jacc.2017.11.008
L2  - http://dx.doi.org/10.1016/j.jacc.2017.11.008
N2  - BACKGROUND Early outcomes of patients in the PRAGUE-18 (Comparison of Prasugrel and Ticagrelor in the Treatment of Acute Myocardial Infarction) study did not find any significant differences between 2 potent P2Y(12) inhibitors. OBJECTIVES The 1-year follow-up of the PRAGUE-18 study focused on: 1) a comparison of efficacy and safety between prasugrel and ticagrelor; and 2) the risk of major ischemic events related to an economically motivated post-discharge switch to clopidogrel. METHODS A total of 1,230 patients with acute myocardial infarction (MI) treated with primary percutaneous coronary intervention were randomized to prasugrel or ticagrelor with an intended treatment duration of 12 months. The combined endpoint was cardiovascular death, MI, or stroke at 1 year. Because patients had to cover the costs of study medication after hospital discharge, some patients decided to switch to clopidogrel. RESULTS The endpoint occurred in 6.6% of prasugrel patients and in 5.7% of ticagrelor patients (hazard ratio: 1.167; 95% confidence interval: 0.742 to 1.835; p = 0.503). No significant differences were found in: cardiovascular death (3.3% vs. 3.0%; p = 0.769), MI (3.0% vs. 2.5%; p = 0.611), stroke (1.1% vs. 0.7%; p = 0.423), all-cause death (4.7% vs. 4.2%; p = 0.654), definite stent thrombosis (1.1% vs. 1.5%; p = 0.535), all bleeding (10.9% vs. 11.1%; p = 0.999), and TIMI (Thrombolysis In Myocardial Infarction) major bleeding (0.9% vs. 0.7%; p = 0.754). The percentage of patients who switched to clopidogrel for economic reasons was 34.1% (n = 216) for prasugrel and 44.4% (n = 265) for ticagrelor (p = 0.003). Patients who were economically motivated to switch to clopidogrel had (compared with patients who continued the study medications) a lower risk of major cardiovascular events; however, they also had lower ischemic risk. CONCLUSIONS Prasugrel and ticagrelor are similarly effective during the first year after MI. Economically motivated early post-discharge switches to clopidogrel were not associated with an increased risk of ischemic events. (Comparison of Prasugrel and Ticagrelor in the Treatment of Acute Myocardial Infarction [PRAGUE-18]; NCT02808767) (c) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
ER  -

MOTOVSKA, Zuzana, Ota HLINOMAZ, Petr KALA, Milan HROMADKA, Jiri KNOT, Ivo VARVAROVSKY, Jaroslav DUSEK, Jiří JARKOVSKÝ, Roman MIKLÍK, Richard ROKYTA, Frantisek TOUSEK, Petra KRAMÁRIKOVÁ, Michal SVOBODA, Bohumil MAJTAN, Stanislav SIMEK, Marian BRANNY, Jan MROZEK, Pavel CERVINKA, Jiri OSTRANSKY and Petr WIDIMSKY. 1-Year Outcomes of Patients Undergoing Primary Angioplasty for Myocardial Infarction Treated With Prasugrel Versus Ticagrelor. \textit{Journal of the American College of Cardiology}. New York: Elsevier Science INC, 2018, vol.~71, No~4, p.~371-381. ISSN~0735-1097. Available from: https://dx.doi.org/10.1016/j.jacc.2017.11.008.

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