Efficacy and safety of ticagrelor versus prasugrel in smokers and nonsmokers with acute coronary syndromes

• Published in: International journal of cardiology Vol. 338; pp. 8 - 13
• Main Authors: Lahu, Shqipdona, Ndrepepa, Gjin, Gewalt, Senta, Schüpke, Stefanie, Pellegrini, Costanza, Bernlochner, Isabell, Aytekin, Alp, Neumann, Franz-Josef, Menichelli, Maurizio, Richardt, Gert, Cassese, Salvatore, Xhepa, Erion, Kufner, Sebastian, Sager, Hendrik B., Joner, Michael, Ibrahim, Tareq, Fusaro, Massimiliano, Laugwitz, Karl-Ludwig, Schunkert, Heribert, Kastrati, Adnan, Mayer, Katharina
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2021
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - drug therapy; Acute Coronary Syndrome - epidemiology; Humans; Non-Smokers; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors - adverse effects; Prasugrel; Prasugrel Hydrochloride - adverse effects; Smokers; Smoking; Ticagrelor; Ticagrelor - adverse effects; Treatment Outcome; Prasugrel; Percutaneous coronary intervention; Acute coronary syndrome; Ticagrelor; Smoking
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2021.06.011

The efficacy and safety of ticagrelor versus prasugrel according to smoking status in patients with acute coronary syndromes (ACS) are not known. We assessed the efficacy and safety of ticagrelor versus prasugrel according to smoking status in patients with ACS undergoing invasive management. This pre-specified analysis of the ISAR-REACT 5 trial included 1349 smokers and 2652 nonsmokers randomized to receive ticagrelor or prasugrel. The primary endpoint was the incidence of death, myocardial infarction, or stroke; the secondary endpoint was the incidence of Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding (both endpoints assessed at 12 months). There was no significant treatment arm-by-smoking status interaction regarding the efficacy outcome. The primary endpoint occurred in 47 patients (7.0%) in the ticagrelor group and 41 patients (6.2%) in the prasugrel group in smokers (hazard ratio [HR] = 1.15; 95% confidence interval [CI] 0.76–1.75; P = 0.510) and in 133 patients (10.2%) in the ticagrelor group and 94 patients (7.2%) in the prasugrel group in nonsmokers (HR = 1.44 [1.10–1.87]; P = 0.007; P for interaction = 0.378). The secondary endpoint occurred in 27 patients (4.6%) in the ticagrelor group and 33 patients (5.6%) in the prasugrel group in smokers (HR = 0.81 [0.49–1.35]; P = 0.412) and in 66 patients (6.0%) in the ticagrelor group and 46 patients (4.4%) in the prasugrel group in nonsmokers (HR = 1.38 [0.94–2.01]; P = 0.097). In patients with ACS undergoing an invasive management strategy, the smoking status did not significantly interact with the relative treatment effect of ticagrelor vs. prasugrel. NCT01944800 •In ACS patients, ticagrelor and prasugrel showed similar efficacy regardless of smoking status.•Bleeding risk was comparable between ticagrelor and prasugrel in smokers and nonsmokers.•Smoking status does not interfere with the relative treatment effect of ticagrelor vs. prasugrel.