Ticagrelor or prasugrel in patients with acute coronary syndrome with off-hour versus on-hour presentation: a subgroup analysis of the ISAR-REACT 5 trial

Medientyp: E-Artikel
Titel: Ticagrelor or prasugrel in patients with acute coronary syndrome with off-hour versus on-hour presentation: a subgroup analysis of the ISAR-REACT 5 trial
Beteiligte: Behnes, Michael; Lahu, Shqipdona; Ndrepepa, Gjin; Menichelli, Maurizio; Mayer, Katharina; Wöhrle, Jochen; Bernlochner, Isabell; Gewalt, Senta; Witzenbichler, Bernhard; Hochholzer, Willibald; Sibbing, Dirk; Cassese, Salvatore; Angiolillo, Dominick J.; Hemetsberger, Rayyan; Valina, Christian; Müller, Arne; Kufner, Sebastian; Hamm, Christian W.; Xhepa, Erion; Hapfelmeier, Alexander; Sager, Hendrik B.; Joner, Michael; Fusaro, Massimiliano; Richardt, Gert; [...]
Erschienen: Springer Science and Business Media LLC, 2023
Erschienen in: Clinical Research in Cardiology
Sprache: Englisch
DOI: 10.1007/s00392-022-02040-z
ISSN: 1861-0684; 1861-0692
Schlagwörter: Cardiology and Cardiovascular Medicine ; General Medicine
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Beschreibung: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Objectives</jats:title> <jats:p>To assess the efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndrome (ACS) presenting during off- and on-hours.</jats:p> </jats:sec><jats:sec> <jats:title>Background</jats:title> <jats:p>The efficacy and safety of ticagrelor versus prasugrel in patients with ACS according to time of hospital presentation remain unknown.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>This post hoc analysis of the ISAR-REACT 5 trial included 1565 patients with ACS presenting off-hours and 2453 patients presenting on-hours, randomized to ticagrelor or prasugrel. The primary endpoint was a composite of death, myocardial infarction, or stroke; the safety endpoint was Bleeding Academic Research Consortium (BARC) type 3–5 bleeding, both at 12 months.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>The primary endpoint occurred in 80 patients (10.4%) in the ticagrelor group and 57 patients (7.3%) in the prasugrel group in patients presenting off-hours (hazard ratio [HR] = 1.45; 95% confidence interval [CI] 1.03–2.03; <jats:italic>P</jats:italic> = 0.033), and 104 patients (8.5%) in the ticagrelor group and 80 patients (6.7%) in the prasugrel group in patients presenting on-hours (HR = 1.29 [0.97–1.73]; <jats:italic>P</jats:italic> = 0.085), without significant treatment arm-by-presentation time interaction (P<jats:sub>int</jats:sub> = 0.62). BARC type 3 to 5 bleeding occurred in 35 patients (5.1%) in the ticagrelor group and 37 patients (5.3%) in the prasugrel group (<jats:italic>P</jats:italic> = 0.84) in patients presenting off-hours, and 60 patients (5.9%) in the ticagrelor group and 43 patients (4.6%) in the prasugrel group in patients presenting on-hours (<jats:italic>P</jats:italic> = 0.17).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In patients with ACS planned to undergo an invasive treatment strategy, time of presentation (off-hours vs. on-hours) does not interact significantly with the relative efficacy and safety of ticagrelor vs. prasugrel.</jats:p> </jats:sec><jats:sec> <jats:title>Clinical trial registration.</jats:title> <jats:p>NCT01944800.</jats:p> </jats:sec><jats:sec> <jats:title>Graphical abstract</jats:title> </jats:sec>

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