Comparison of ticagrelor and prasugrel just before PCI in NSTE acute coronary syndromes, LIKE-ACCOAST analysis

Abstract Background Recommendations for the preference of prasugrel over ticagrelor just before PCI in NSTE ACS are based on limited and controversial evidence. Furthermore, prasugrel can’t be used in patients after a stroke/TIA, and the risk of bleeding in older and low-weight patients annuls its benefit. Purpose We aimed to add to the current evidence comparing the benefit of prasugrel and ticagrelor just before PCI (without pretreatment) in NSTE ACS patients. Methods The prasugrel population comprised the ACCOAST study non-pretreatment arm undergoing PCI (N 1372) (ref 1). The ticagrelor study population was selected from the long-term all-comers National Registry of Cardiovascular Surgery and Interventions: Module of Cardiovascular interventions of Institute of Health Information and Statistics of the Czech Republic (N 15126)who were 1) undergoing PCI for NSTE ACS, 2) received ticagrelor loading dose 180 mg just before the procedure, 3) fulfilled the inclusion and exclusion criteria of the ACCOAST trial (N 1370). The endpoint (identically to the ACCOAST primary EP) was a composite of cardiovascular death, myocardial infarction, stroke, urgent revascularization, or glycoprotein IIb/IIIa bailout seven days after PCI. The data were matched to the structure of published ACCOAST no pre-treatment group using R with maic package, which provides a generalized workflow for the generation of subject weights to be used in Matching-Adjusted Indirect Comparison (MAIC) (Ref 3,4). In MAIC, unbiased comparison between outcomes of two trials is facilitated by weighting the subject-level outcomes of one trial with weights derived such that the weighted aggregate measures of the prognostic or effect modifying variables are equal to those of the sample in the comparator trial. Results The study population characteristics are presented in Table. We did not find any difference in the efficacy endpoint at seven and 30 days after PCI between the groups treated with prasugrel and ticagrelor (Figure). Conclusion Prasugrel and ticagrelor given just before PCI for NSTE ACS are equally effective in reducing ischemic risk.Table.Efficacy endpoint occurence.