Читать книгу Interventional Cardiology - Группа авторов - Страница 320

In terms of direct head‐to‐head comparisons between prasugrel and ticagrelor, the initial STEMI data was provided by the PRAGUE‐18 study [52], which randomized a total of 1230 patients with AMI being treated with primary PCI to either prasugrel or ticagrelor. This study was terminated early for futility, with no significant difference being seen in any of the components of the primary end point (death, reinfarction, urgent target vessel revascularization, stroke or serious bleeding at seven days). However, this trial is underpowered and medication was switched to clopidogrel after hospital discharge in many patients for reimbursement issues in the Czech Republic, thus limiting the results.

However, in the ISAR‐REACT 5 trial [53], a multicenter, randomized, open‐label trial which randomly assigned patients who presented with ACS and for whom invasive evaluation was planned to either receive ticagrelor or prasugrel, the hazard ratio for the primary endpoint of death, myocardial infarction or stroke at one year was 1.36 (95% CI 1.09–1.70; p = 0.006) for ticagrelor as compared to prasugrel. This result is for the ACS population in general, however, is made up of approx. 40% STEMI presentations.