Prasugrel and ticagrelor had similar safety and efficacy among patients with acute myocardial infarction (MI) and ST segment elevations (STEMI), according to early results from the PRAGUE-18 study presented Aug. 30 during ESC Congress 2016 in Rome, and simultaneously published in Circulation. Final one-year follow up for all patients is expected to be completed in 2017.

The trial randomized 1,230 STEMI patients to receive either prasugrel or ticagrelor prior to primary percutaneous coronary intervention. The primary end-point was defined as death, re-infarction, urgent target vessel revascularization, stroke, serious bleeding requiring transfusion or prolonged hospitalization at seven days.

The trial was stopped prematurely after an interim analysis showed no difference in the rate of this endpoint between groups (4.0 percent and 4.1 percent in the prasugrel and ticagrelor groups, respectively; P=0.939). Results also showed no difference between groups in the rate of the key secondary end-point, composed of cardiovascular death, non-fatal MI or stroke within 30 days (2.7 percent and 2.5 percent, respectively; P=0.864).

“Our findings confirm previous indirect, non-randomized comparisons of these two drugs, based on analyses of various registries,” commented Petr Widimsky, MD, DSc, FACC, from the Cardiocenter of Charles University, in Prague, Czech Republic. “Thus, both drugs are very effective and safe and significantly contribute to the excellent outcomes of patients with acute MI in modern cardiology.”  

Keywords: ESC Congress, Adenosine, Myocardial Infarction, Purinergic P2Y Receptor Antagonists, Angiography

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