The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Cardiology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
JACC Cardiovasc Interv. 2022 Nov 28;15(22):2270-2280. doi: 10.1016/j.jcin.2022.09.021.
Potent P2Y agents such as ticagrelor and prasugrel are increasingly utilized across the clinical spectrum of patients undergoing percutaneous coronary intervention (PCI). There is a paucity of data supporting their use in a patient population inclusive of both acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) patients.
The authors compared the efficacy and safety of ticagrelor and prasugrel in a real-world contemporary PCI cohort.
Consecutive patients undergoing PCI between 2014 and 2019 discharged on either prasugrel or ticagrelor were included from the prospectively collected institutional PCI registry. Primary endpoint was the composite of death and myocardial infarction (MI), with secondary outcomes including rates of bleeding, stroke, and target vessel revascularization at 1 year.
Overall, 3,858 patients were included in the study (ticagrelor: n = 2,771; prasugrel: n = 1,087), and a majority (48.4%) underwent PCI in the context of CCS. Patients prescribed ticagrelor were more likely to be female, have a history of cerebrovascular disease, and have ACS presentation, while those receiving prasugrel were more likely to be White with a higher prevalence of prior revascularization. No difference in the risk of death or MI was noted across the groups (ticagrelor vs prasugrel: 3.3% vs 3.1%; HR: 0.88; 95% CI: 0.54-1.43; P = 0.59). Rates of target vessel revascularization were significantly lower in the ticagrelor cohort (9.3% vs 14.0%; adjusted HR: 0.71; 95% CI: 0.55-0.91; P = 0.007) with no differences in stroke or bleeding. The results were consistent in patients with CCS (HR: 0.84; 95% CI: 0.46-1.54) and ACS (HR: 1.18; 95% CI: 0.46-1.54), without evidence of interaction (P = 0.37), and confirmed across multivariable adjustment and propensity score stratification analysis.
In this contemporary patient population undergoing PCI, prasugrel and ticagrelor were associated with similar 1-year efficacy and safety.
替格瑞洛和普拉格雷等强效 P2Y 拮抗剂在接受经皮冠状动脉介入治疗（PCI）的患者的临床治疗中得到了越来越广泛的应用。然而，目前尚缺乏支持此类药物应用于急性冠脉综合征（ACS）和慢性冠脉综合征（CCS）患者的相关数据。
作者旨在比较替格瑞洛和普拉格雷在真实世界中当代 PCI 队列中的疗效和安全性。
该研究纳入了 2014 年至 2019 年期间接受 PCI 治疗并出院后接受普拉格雷或替格瑞洛治疗的连续患者，这些患者来自前瞻性收集的机构 PCI 注册中心。主要终点是死亡和心肌梗死（MI）的复合终点，次要终点包括 1 年内出血、卒中和靶血管血运重建的发生率。
总体而言，研究纳入了 3858 例患者（替格瑞洛组：n=2771；普拉格雷组：n=1087），其中大多数（48.4%）患者因 CCS 接受 PCI 治疗。与接受普拉格雷治疗的患者相比，接受替格瑞洛治疗的患者更可能为女性、有脑血管疾病史和 ACS 表现，而接受普拉格雷治疗的患者更可能为白人，且先前血运重建的发生率更高。两组之间死亡或 MI 的风险无显著差异（替格瑞洛组 vs 普拉格雷组：3.3% vs 3.1%；HR：0.88；95%CI：0.54-1.43；P=0.59）。替格瑞洛组靶血管血运重建的发生率显著低于普拉格雷组（9.3% vs 14.0%；调整后的 HR：0.71；95%CI：0.55-0.91；P=0.007），两组之间卒中和出血无差异。在 CCS 患者（HR：0.84；95%CI：0.46-1.54）和 ACS 患者（HR：1.18；95%CI：0.46-1.54）中，结果均一致，且无交互作用的证据（P=0.37），并通过多变量调整和倾向评分分层分析得到证实。
在这一当代 PCI 患者人群中，普拉格雷和替格瑞洛的 1 年疗效和安全性相当。
