July 01, 2021
Among patients with ACS who undergo PCI, a prasugrel-based strategy is superior to one using ticagrelor in terms of all-cause death, MI, and stroke at 12 months, according to a prespecified subanalysis of the ISAR-REACT 5 trial.
Researchers here had narrowed their focus to only patients who actually were treated with PCI after being randomized to prasugrel versus ticagrelor representing 84.4% of study participants.
While the initial findings of ISAR-REACT 5, as reported by TCTMD in 2019, were a surprise to the investigators, who had hypothesized that ticagrelor would hold an advantage. Prior evidence had shown increased bleeding associated with prasugrel, but this was not shown to be the case in ISAR-REACT 5, and, subsequently, the 2020 European Society of Cardiology guidelines for NSTE ACS were updated to back a prasugrel-based strategy.