TY - JOUR
T1 - Impact of shifting from routine use of ticagrelor to prasugrel in myocardial infarction patients after PCI
T2 - a nationwide cohort study
AU - Jacobsen, Mia Ravn
AU - Graversen, Peter Laursen
AU - Jabbari, Reza
AU - Grove, Erik Lerkevang
AU - Glinge, Charlotte
AU - Holmvang, Lene
AU - Geisler, Tobias
AU - Køber, Lars
AU - Torp-Pedersen, Christian
AU - Engstrøm, Thomas
AU - Sørensen, Rikke
PY - 2025/11/3
Y1 - 2025/11/3
N2 - BACKGROUND: In 2020, the Danish national guidelines changed to recommend prasugrel over ticagrelor in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI), prior to the 2023 update to the European guidelines.AIMS: We aimed to assess whether the shift from routine use of ticagrelor to prasugrel was implemented on a national level and whether prasugrel was associated with lower rates of major adverse cardiovascular events (MACE) and with similar bleeding rates compared to ticagrelor.METHODS: This register-based cohort study identified MI patients treated with PCI from 2019 to 2022 using Danish nationwide registries. Patients without contraindications were included if they were alive and redeemed a prasugrel or ticagrelor prescription within 7 days from discharge.RESULTS: In total, 10,984 patients redeemed prasugrel (38.0%) or ticagrelor (62.0%). In 2019, >99% of patients were treated with ticagrelor. By 2022, 89% of patients were treated with prasugrel. Prasugrel-treated patients were younger, more often male, had ST-segment elevation MI (STEMI) more frequently, and had fewer cardiovascular comorbidities than ticagrelor-treated patients. P2Y12 inhibitor adherence was high, and 4.3% of patients switched from prasugrel and 18.8% from ticagrelor. Prasugrel was associated with reduced 1-year rates of MACE (adjusted hazard ratio [adjHR] 0.67, 95% confidence interval [CI]: 0.47-0.95) and MI (adjHR 0.65, 95% CI: 0.44-0.96) compared with ticagrelor, without differences in bleeding after adjustment. These findings were replicated in a propensity score-matched population, in patients aged ≥75 years, and in non-STEMI patients.CONCLUSIONS: A shift from ticagrelor to prasugrel occurred between 2019 and 2022 among real-world MI patients post-PCI. Prasugrel was associated with reduced rates of MACE and MI and with similar bleeding rates compared with ticagrelor, supporting current guideline recommendations.
AB - BACKGROUND: In 2020, the Danish national guidelines changed to recommend prasugrel over ticagrelor in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI), prior to the 2023 update to the European guidelines.AIMS: We aimed to assess whether the shift from routine use of ticagrelor to prasugrel was implemented on a national level and whether prasugrel was associated with lower rates of major adverse cardiovascular events (MACE) and with similar bleeding rates compared to ticagrelor.METHODS: This register-based cohort study identified MI patients treated with PCI from 2019 to 2022 using Danish nationwide registries. Patients without contraindications were included if they were alive and redeemed a prasugrel or ticagrelor prescription within 7 days from discharge.RESULTS: In total, 10,984 patients redeemed prasugrel (38.0%) or ticagrelor (62.0%). In 2019, >99% of patients were treated with ticagrelor. By 2022, 89% of patients were treated with prasugrel. Prasugrel-treated patients were younger, more often male, had ST-segment elevation MI (STEMI) more frequently, and had fewer cardiovascular comorbidities than ticagrelor-treated patients. P2Y12 inhibitor adherence was high, and 4.3% of patients switched from prasugrel and 18.8% from ticagrelor. Prasugrel was associated with reduced 1-year rates of MACE (adjusted hazard ratio [adjHR] 0.67, 95% confidence interval [CI]: 0.47-0.95) and MI (adjHR 0.65, 95% CI: 0.44-0.96) compared with ticagrelor, without differences in bleeding after adjustment. These findings were replicated in a propensity score-matched population, in patients aged ≥75 years, and in non-STEMI patients.CONCLUSIONS: A shift from ticagrelor to prasugrel occurred between 2019 and 2022 among real-world MI patients post-PCI. Prasugrel was associated with reduced rates of MACE and MI and with similar bleeding rates compared with ticagrelor, supporting current guideline recommendations.
KW - Humans
KW - Prasugrel Hydrochloride/therapeutic use
KW - Ticagrelor/therapeutic use
KW - Male
KW - Female
KW - Percutaneous Coronary Intervention/methods
KW - Aged
KW - Platelet Aggregation Inhibitors/therapeutic use
KW - Middle Aged
KW - Myocardial Infarction/therapy
KW - Denmark/epidemiology
KW - Registries
KW - Cohort Studies
KW - Hemorrhage/chemically induced
KW - Treatment Outcome
KW - Purinergic P2Y Receptor Antagonists/therapeutic use
KW - prasugrel
KW - myocardial infarction
KW - ticagrelor
KW - dual antiplatelet therapy
KW - percutaneous coronary intervention
KW - guideline-recommended treatment
UR - https://www.scopus.com/pages/publications/105023119446
U2 - 10.4244/EIJ-D-25-00132
DO - 10.4244/EIJ-D-25-00132
M3 - Journal article
C2 - 41489712
SN - 1774-024X
VL - 21
SP - e1259-e1268
JO - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
JF - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
IS - 21
ER -