Ticagrelor and prasugrel are independent predictors of improved long‐term survival in ACS patients

Gager, Gloria M; Jilma, Bernd; Winter, Max‐Paul; Hengstenberg, Christian; Lang, Irene; Toma, Aurel; Prüller, Florian; Wallner, Markus; Kolesnik, Ewald; Lewinski, Dirk von; Siller‐Matula, Jolanta M.

doi:10.1111/eci.13304

Cited by 7 publications

(8 citation statements)

References 64 publications

(125 reference statements)

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“…The overall methodological quality of 14 cohort studies was generally high with the NOS scores ranged from 6 to 9 (Table 3). Six (27,31,40,(42)(43)(44) studies were rated six stars, three (24,28,41) were rated seven stars, four (23,38,45,46) were rated eight stars, and one (32) was rated nine stars.…”

Section: Methodological Qualitymentioning

confidence: 99%

“…Among included studies, 11 (25, 26, 29, 30, 33-37, 39, 47) studies were RCTs, 13 (23,24,27,31,32,38,(40)(41)(42)(43)(44)(45)(46) studies were prospective cohort studies, and one ( 28) study was retrospective cohort study. The publication dates of 25 studies ranged from 2012 to 2022.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seven (24,25,27,30,34,35,47) studies only tested platelet function after the treatment of LD. Seventeen (23,28,29,(31)(32)(33)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) studies only tested platelet function after the treatment of MTD. One ( 26) study tested platelet function after the treatment of LD and MTD.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seven (31,(41)(42)(43)(44)(45)(46)) studies compared the incidence of HTPR based on AUC after MTD in ticagrelor group and prasugrel group. According to the MEA test, the incidence of HTPR after MTD of the two groups was not significantly different [RR = 0.70 (0.44, 1.11), P = 0.13].…”

Section: Htpr After Mtdmentioning

confidence: 99%

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Impact of Prasugrel and Ticagrelor on Platelet Reactivity in Patients With Acute Coronary Syndrome: A Meta-Analysis

Dai

Jiang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThis meta-analysis mainly aimed to compare the impact of prasugrel and ticagrelor on platelet reactivity (PR) in patients with acute coronary syndrome (ACS).MethodsWe searched four electronic databases to identify randomized controlled trials and cohort studies comparing the impact of prasugrel and ticagrelor on PR in patients with ACS. We performed group analyses according to three detection methods, drug dose [loading dose (LD) and maintenance dose (MTD)] and LD effect time, and assessed the robustness of the results through sensitivity analysis.ResultsTwenty-five studies with 5,098 patients were eligible. After LD, the incidence of high on-treatment platelet reactivity (HTPR) of ticagrelor was significantly lower than that of prasugrel within 6–18 h based on vasodilator-stimulated phosphoprotein (VASP) test [RR = 0.25 (0.07, 0.85), P = 0.03], there was no significant difference between ticagrelor and prasugrel in the following results: platelets inhibitory effect within 24–48 h based on VerifyNow P2Y12 (VN) assay (P = 0.11) and VASP test (P = 0.20), and the incidence of HTPR within 2–6 h based on VN assay (P = 0.57) and within 24–48 h based on VN assay (P = 0.46) and VASP test (P = 0.72), the incidence of low on-treatment platelet reactivity (LTPR) within 6–18 h based on VASP test (P = 0.46) and 48 h based on VN assay (P = 0.97) and VASP test (P = 0.73). After MTD, the platelet inhibitory effect of ticagrelor was stronger than that of prasugrel based on VN assay [WMD = −41.64 (−47.16, −36.11), P < 0.00001]and VASP test [WMD = −9.10 (−13.88, −4.32), P = 0.0002], the incidence of HTPR of ticagrelor was significantly lower than that of prasugrel based on VN assay [RR = 0.05 (0.02, 0.16), P < 0.00001], the incidence of LTPR of ticagrelor was significantly higher than prasugrel based on VN assay [RR = 6.54 (4.21, 10.14), P < 0.00001] and VASP test [RR = 2.65 (1.78, 3.96), P < 0.00001], the results of Multiple Electrode Aggregometry (MEA) test was inconsistent with the other two detection methods in platelet inhibitory effect and the incidence of HTPR and LTPR. There was no significant difference between ticagrelor and prasugrel in the following clinical outcomes: all-cause death (P = 0.86), cardiovascular death (P = 0.49), myocardial infarction (P = 0.67), stroke (P = 0.51), target vessel revascularization (P = 0.51), stent thrombosis (P = 0.90), TIMI major bleeding (P = 0.86) and bleeding BARC type ≥ 2 (P = 0.77). The risk of bleeding BARC type 1 of ticagrelor was significantly higher than prasugrel [RR = 1.44 (1.03, 2.02), P = 0.03].ConclusionsCompared with prasugrel, ticagrelor might have a stronger platelet inhibition effect, with a lower incidence of HTPR and a higher incidence of LTPR and bleeding BARC type 1, while there might be no significant difference in the risk of thrombosis/ischemic, bleeding BARC Type ≥ 2 and TIMI major bleeding. A higher incidence of LTPR might indicate a higher risk of bleeding BARC type 1. The results of VN assay were consistent with that of VASP test, and not with the MEA test.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022304205, identifier: CRD42022304205.

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Section: Methodological Qualitymentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Htpr After Mtdmentioning

confidence: 99%

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Impact of Prasugrel and Ticagrelor on Platelet Reactivity in Patients With Acute Coronary Syndrome: A Meta-Analysis

Dai

Jiang

et al. 2022

Front. Cardiovasc. Med.

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“…The clinical prognosis of patients presenting with acute myocardial infarction (AMI) has improved over time due to several factors as the introduction of potent platelet inhibitors, 1–5 improvement in dosing and combinations of drugs 6 and in stent technologies. 7 Nevertheless, AMI patients still experience adverse events, which might be related to the residual inflammation, for which C-reactive protein (CRP) is an established biomarker.…”

Section: Introductionmentioning

confidence: 99%

Comparison of high-sensitivity C-reactive protein vs. C-reactive protein for diagnostic accuracy and prediction of mortality in patients with acute myocardial infarction

et al. 2021

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Background: The role of chronic inflammation in the pathogenesis of atherosclerosis has been unequivocally proven. However, the prognostic impact of C-reactive protein (CRP), a marker of inflammatory response in patients with acute myocardial infarction (AMI) has not been fully clarified. Furthermore, there is no direct comparison of the diagnostic accuracy of CRP and high sensitivity C-reactive protein (hsCRP) in the AMI population. Methods: In this prospective observational cohort study, 344 patients with AMI were enrolled. All-cause mortality was a primary endpoint. Patients were followed prospectively for a median of 6 years. Results: The correlation between hsCRP and CRP (r =0.99; p <0.001) and the diagnostic accuracy (98.6%) were high. The ROC analysis revealed that CRP and hsCRP had a low AUC for prediction of mortality (CRP: 0.565, 95% CI [0.462â0.669], vs. hsCRP: 0.572, 95% CI [0.470â0.675]) or MACE (CRP: AUC 0.607, 95% CI [0.405â0.660], vs. hsCRP: AUC 0.526, 95% CI [0.398â0.653]) when assessed at time point of AMI. In contrast, longitudinal inflammatory risk assessment with serial CRP measurements in the stable phase of the disease revealed a 100% specificity, 100% negative predictive value, 32% sensitivity, and 12% positive predictive value of CRP to predict long-term mortality. The Kaplan Meier analysis showed a significant survival benefit for patients at low residual inflammatory risk (p = 0.014). Conclusion: CRP and hsCRP provide a similar diagnostic accuracy, highlighting that CRP might replace hsCRP in routine assessments. Furthermore, low inflammatory status during the stable phase after AMI predicts favorable 6-year survival.

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High concentration of symmetric dimethylarginine is associated with low platelet reactivity and increased bleeding risk in patients with acute coronary syndrome

Eyileten

Nowak

Jarosz-Popek

et al. 2022

Thrombosis Research

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Ticagrelor and prasugrel are independent predictors of improved long‐term survival in ACS patients

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 7 publications

References 64 publications

Impact of Prasugrel and Ticagrelor on Platelet Reactivity in Patients With Acute Coronary Syndrome: A Meta-Analysis

Impact of Prasugrel and Ticagrelor on Platelet Reactivity in Patients With Acute Coronary Syndrome: A Meta-Analysis

Comparison of high-sensitivity C-reactive protein vs. C-reactive protein for diagnostic accuracy and prediction of mortality in patients with acute myocardial infarction

High concentration of symmetric dimethylarginine is associated with low platelet reactivity and increased bleeding risk in patients with acute coronary syndrome

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