Lahu Shqipdona, Ndrepepa Gjin, Neumann Franz-Josef, Menichelli Maurizio, Bernlochner Isabell, Richardt Gert, Wöhrle Jochen, Witzenbichler Bernhard, Hemetsberger Rayyan, Mayer Katharina, Akin Ibrahim, Cassese Salvatore, Gewalt Senta, Xhepa Erion, Kufner Sebastian, Valina Christian, Sager Hendrik B, Joner Michael, Ibrahim Tareq, Laugwitz Karl-Ludwig, Schunkert Heribert, Schüpke Stefanie, Kastrati Adnan
Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
Eur Heart J Cardiovasc Pharmacother. 2022 Sep 29;8(7):687-694. doi: 10.1093/ehjcvp/pvac007.
To assess whether the efficacy and safety of ticagrelor vs. prasugrel in patients with acute coronary syndromes (ACSs) are influenced by pre-admission treatment with aspirin and/or clopidogrel.
Patients (n = 4018) were categorized into two groups: pre-admission aspirin and/or clopidogrel group (n = 1455) and no pre-admission aspirin or clopidogrel group (n = 2563). The primary endpoint was the composite of all-cause death, myocardial infarction, or stroke; the secondary safety endpoint was Bleeding Academic Research Consortium (BARC) type 3-5 bleeding, both at 1 year. Patients in the pre-admission aspirin and/or clopidogrel group had a higher risk of ischaemic events, but a similar risk of bleeding to patients in the no pre-admission aspirin or clopidogrel group (cumulative incidences 10.5% vs. 6.7%, and 5.7% vs. 5.7%, respectively). The primary endpoint occurred in 81/717 patients assigned to ticagrelor and 69/738 patients assigned to prasugrel in the pre-admission aspirin and/or clopidogrel group [11.5% vs. 9.5%; hazard ratio (HR) = 1.23; 95% confidence interval (CI) 0.89-1.69], and in 103/1295 patients assigned to ticagrelor and 68/1268 patients assigned to prasugrel in the no pre-admission aspirin or clopidogrel group [8.0% vs. 5.4%; HR = 1.50 (1.10-2.03); Pint = 0.38]. BARC type 3-5 bleeding events did not differ between ticagrelor and prasugrel in patients in the pre-admission aspirin and/or clopidogrel (6.2% vs. 4.5%) or no pre-admission aspirin or clopidogrel (5.3% vs. 5.1%) group (Pint = 0.54).
In patients with ACS, pre-admission therapy with aspirin and/or clopidogrel has no influence on the relative efficacy and safety of ticagrelor and prasugrel.
评估急性冠状动脉综合征（ACS）患者中，替格瑞洛与普拉格雷的疗效和安全性是否受入院前阿司匹林和/或氯吡格雷治疗的影响。
患者（n = 4018）被分为两组：入院前使用阿司匹林和/或氯吡格雷组（n = 1455）和入院前未使用阿司匹林或氯吡格雷组（n = 2563）。主要终点为全因死亡、心肌梗死或卒中的复合终点；次要安全性终点为1年时的出血学术研究联盟（BARC）3 - 5型出血。入院前使用阿司匹林和/或氯吡格雷组患者发生缺血事件的风险较高，但出血风险与入院前未使用阿司匹林或氯吡格雷组患者相似（累积发生率分别为10.5%对6.7%，以及5.7%对5.7%）。在入院前使用阿司匹林和/或氯吡格雷组中，分配至替格瑞洛的717例患者中有81例、分配至普拉格雷的738例患者中有69例发生主要终点事件[11.5%对9.5%；风险比（HR）= 1.23；95%置信区间（CI）0.89 - 1.69]；在入院前未使用阿司匹林或氯吡格雷组中，分配至替格瑞洛的1295例患者中有103例、分配至普拉格雷的1268例患者中有68例发生主要终点事件[8.0%对5.4%；HR = 1.50（1.10 - 2.03）；P交互 = 0.38]。在入院前使用阿司匹林和/或氯吡格雷组（6.2%对4.5%）或入院前未使用阿司匹林或氯吡格雷组（5.3%对5.1%）中，替格瑞洛和普拉格雷之间的BARC 3 - 5型出血事件无差异（P交互 = 0.54）。
在ACS患者中，入院前使用阿司匹林和/或氯吡格雷治疗对替格瑞洛和普拉格雷的相对疗效和安全性无影响。
