# Ticagrelor of prasugrel bij STEMI met primaire PCI: ISAR-REACT 5 STEMI

*geplaatst 2020-12-15 · Algemeen · Circulation · doi 10.1161/CIRCULATIONAHA.120.050244 · https://hartvaat.nl/2020/12/15/ticagrelor-of-prasugrel-bij-stemi-met-primaire-pci-isar-react-5-stemi/*

ISAR-REACT 5 subanalyse specifiek bij STEMI met primaire PCI. Prasugrel-voordeel consistent bij STEMI.

## English: Ticagrelor or Prasugrel in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.120.050244. Bijgewerkt 2026-07-03T13:28:06Z. 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.