{"id":"cdff7d129dfe","type":"article","url":"https://hartvaat.nl/2020/12/15/ticagrelor-of-prasugrel-bij-stemi-met-primaire-pci-isar-react-5-stemi/","title":"Ticagrelor of prasugrel bij STEMI met primaire PCI: ISAR-REACT 5 STEMI","title_en":"Ticagrelor or Prasugrel in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.050244","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.050244","authors":["Alp Aytekin","Gjin Ndrepepa","Franz-Josef Neumann","Maurizio Menichelli","Katharina Mayer","Jochen Wöhrle","Isabell Bernlochner","Shqipdona Lahu","Gert Richardt","Bernhard Witzenbichler","Dirk Sibbing","Salvatore Cassese","Dominick J Angiolillo","Christian Valina","Sebastian Kufner","Christoph Liebetrau","Christian W Hamm","Erion Xhepa","Alexander Hapfelmeier","Hendrik B Sager","Isabel Wustrow","Michael Joner","Dietmar Trenk","Massimiliano Fusaro","Karl-Ludwig Laugwitz","Heribert Schunkert","Stefanie Schüpke","Adnan Kastrati"],"significance":7,"published":"2020-12-15","source_date":"2020-12-15","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This ISAR-REACT 5 subanalysis in STEMI patients undergoing primary PCI confirmed that prasugrel reduces ischemic events compared with ticagrelor, with consistent superiority in the acute MI population.","created":"2026-07-03T10:28:57Z","updated":"2026-07-03T13:28:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ISAR-REACT 5 subanalyse specifiek bij STEMI met primaire PCI. Prasugrel-voordeel consistent bij STEMI.","abstract_original":"BACKGROUND: Data on the comparative efficacy and safety of ticagrelor versus prasugrel in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention are limited. We assessed the efficacy and safety of ticagrelor versus prasugrel in a head-to-head comparison in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS: In this prespecified subgroup analysis, we included 1653 patients with ST-segment-elevation myocardial infarction randomized to receive ticagrelor or prasugrel in the setting of the ISAR REACT-5 trial (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 5). The primary end point was the incidence of death, myocardial infarction, or stroke at 1 year after randomization. The secondary end point was the incidence of bleeding defined as BARC (Bleeding Academic Research Consortium) type 3 to 5 bleeding at 1 year after randomization. RESULTS: The primary end point occurred in 83 patients (10.1%) in the ticagrelor group and in 64 patients (7.9%) in the prasugrel group (hazard ratio, 1.31 [95% CI, 0.95-1.82]; P=0.10). One-year incidence of all-cause death (4.9% versus 4.7%; P=0.83), stroke (1.3% versus 1.0%; P=0.46), and definite stent thrombosis (1.8% versus 1.0%; P=0.15) did not differ significantly in patients assigned to ticagrelor or prasugrel. One-year incidence of myocardial infarction (5.3% versus 2.8%; hazard ratio, 1.95 [95% CI, 1.18-3.23]; P=0.010) was higher with ticagrelor than with prasugrel. BARC type 3 to 5 bleeding occurred in 46 patients (6.1%) in the ticagrelor group and in 39 patients (5.1%) in the prasugrel group (hazard ratio, 1.22 [95% CI, 0.80-1.87]; P=0.36). CONCLUSIONS: In patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, there was no significant difference in the primary end point between prasugrel and ticagrelor. Ticagrelor was associated with a significant increase in the risk for recurrent myocardial infarction. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01944800."}