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Prasugrel vs. Ticagrelor for Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

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Abstract

Background

The newer P2Y12 inhibitors have better efficacy than clopidogrel. However, whether ticagrelor or prasugrel have a better comparative safety and efficacy profile, especially in the long-term, remains inconclusive.

Objective

We compared prasugrel and ticagrelor in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

Methods

MEDLINE and the Cochrane library were queried for randomized controlled trials (RCTs) or observational studies comparing prasugrel with ticagrelor in patients with ACS undergoing PCI. Random-effects pooling was used to calculate odds ratios (ORs) with 95% confidence intervals (CI). Analyses were stratified by duration of follow-up (short term [≤ 3 months] and long term [≥ 1 year]) and study design.

Results

In total, 14 studies (six RCTs, eight observational studies), including 40,188 patients, met eligibility criteria. Pooled analysis did not indicate that prasugrel significantly decreased all-cause mortality compared with ticagrelor in the short term (OR 0.49; 95% CI 0.20–1.20; p = 0.11) or long term (OR 0.74; 95% CI 0.48–1.15; p = 0.38). Pooled observational studies showed significantly lower long-term all-cause mortality (OR 0.63; 95% CI 0.43–0.92; p = 0.02) and short-term stent thrombosis (OR 0.46; 95% CI 0.28–0.75; p = 0.002) with prasugrel. No significant difference was observed in the risk of nonfatal myocardial infarction, ischemic stroke, bleeding, or repeat revascularization between the two groups. Results remained similar after stratification according to follow-up and study design.

Conclusions

The present analysis suggests that prasugrel might have a better efficacy profile than ticagrelor in patients with ACS undergoing PCI. However, this advantage was only seen in pooled observational studies and is likely to be affected by selection bias.

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Authors and Affiliations

  1. Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, 1900 W Harrison Street, Chicago, IL, USA

    Muhammad Shahzeb Khan, Naser Yamani & Setri Fugar

  2. Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

    Muhammad Mustafa Memon & Muhammad Shariq Usman

  3. Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Saed Alnaimat

  4. West Virginia University, Morgantown, WV, USA

    Safi U. Khan

  5. Division of Cardiology, University of Louisville, Louisville, KY, USA

    Abdur Rahman Khan

  6. Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA

    Farouk Mookadam

  7. Department of Cardiovascular Medicine, Duke University Health System, Durham, NC, USA

    Richard A. Krasuski

  8. Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA

    Rami Doukky

  9. Division of Cardiology, Rush University Medical Center, Chicago, IL, USA

    Rami Doukky

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  1. Muhammad Shahzeb Khan
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Correspondence to Muhammad Shahzeb Khan.

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Funding

No sources of external funding were used to conduct this study or prepare this manuscript.

Conflict of interest

MSK, MMM, MSU, SA, SUK, ARK, NY, SF, FM, RAK, and RD have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Ethical approval

Ethical approval was not required as our study does not include confidential participant data and interventions.

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Khan, M.S., Memon, M.M., Usman, M.S. et al. Prasugrel vs. Ticagrelor for Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. Am J Cardiovasc Drugs 19, 465–476 (2019). https://doi.org/10.1007/s40256-019-00337-5

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