Access route and clinical outcomes after ticagrelor versus prasugrel in patients with acute coronary syndrome undergoing invasive treatment strategy

Rayyan Hemetsberger, Gert Richardt, Shqipdona Lahu, Christian Valina, Maurizio Menichelli, Mohammad Abdelghani, Jochen Wöhrle, Ralph Toelg, Bernhard Witzenbichler, Nader Mankerious, Christoph Liebetrau, Isabell Bernlochner, Christian W. Hamm, Abdelhakim Allali, Michael Joner, Massimiliano Fusaro, Erion Xhepa, Alexander Hapfelmeier, Sebastian Kufner, Hendrik B. SagerStefanie Schüpke, Karl-Ludwig Laugwitz, Heribert Schunkert, Franz-Josef Neumann, Adnan Kastrati, Salvatore Cassese

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Abstract

Background: Whether the access site influences the comparative efficacy and safety of ticagrelor and prasugrel in patients with acute coronary syndrome (ACS) undergoing invasive treatment strategy remains unstudied. Methods: This post-hoc analysis included ACS patients undergoing invasive treatment via radial or femoral access and randomized to either ticagrelor or prasugrel in the ISAR-REACT 5 trial. The primary efficacy endpoint was the composite of death, myocardial infarction (MI) or stroke, safety endpoint was BARC 3 to 5 bleeding. Outcomes were assessed out to 12 months after randomization. Results: Out of 4018 patients, 3984 underwent invasive treatment via radial or femoral access. 1479 had coronary angiography via radial access (ticagrelor, N = 748; prasugrel, N = 731) and 2505 via femoral access (ticagrelor, N = 1245; prasugrel, N = 1260). There was no interaction between access route and assignment to either ticagrelor or prasugrel regarding the primary efficacy or safety endpoints (P for interaction≥0.616). In the radial group, the primary efficacy endpoint (7.6% versus 5.8%, HR: 1.32 [0.88–1.97], P = 0.151) and the safety endpoint (4.3% versus 3.0%, HR: 1.36, [0.73–1.31], P = 0.300) were not statistically different in patients receiving either ticagrelor or prasugrel. In the femoral group, the primary efficacy endpoint occurred more frequently in patients assigned to ticagrelor as compared to prasugrel (10.3% versus 7.3%, HR: 1.44 [1.10–1.88], P = 0.006) without significant difference in terms of safety endpoint (6.4% versus 5.8%, HR: 1.14, [0.81–1.60], P = 0.470). Conclusions: In patients with ACS undergoing an invasive treatment strategy, the access route does not influence the comparative efficacy and safety of ticagrelor and prasugrel. SUMMARY FOR THE ANNOTATED TABLE OF CONTENTS: The access route used during the invasive procedure did not significantly affect the relative efficacy of ticagrelor versus prasugrel in ACS patients enrolled in the ISAR-REACT 5 trial. There was also no significant difference in bleeding events between ticagrelor and prasugrel as a function of access route. CLINICAL TRIAL REGISTRATION: NCT01944800
Original languageEnglish
JournalCardiovascular revascularization medicine
Early online date2022
DOIs
Publication statusE-pub ahead of print - 2022

Keywords

  • Acute coronary syndrome
  • Coronary angiography
  • Femoral artery
  • Prasugrel
  • Radial artery
  • Ticagrelor

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