A study comparing P2Y12 Inhibitors in Australian patients undergoing PCI has found that prasugrel in combination with aspirin was associated with better two-year outcomes compared to ticagrelor and clopidogrel.

Prasugrel had significantly lower rates of the composite outcome of death, myocardial infarction and stroke at one and two years after PCI compared to other P2Y12 Inhibitors without an increase in major bleeds, according to Victorian clinicians.

Dr Derk Pol and colleagues at the Royal Melbourne Hospital collected data prospectively from 12,940 patients who were prescribed dual antiplatelet therapy following PCI at  14 sites around Australia between 2008 and 2019.

Patients receiving prasugrel were more likely to be male, younger (mean age 62.3 years), obese and present with STEMI than those receiving either ticagrelor or clopidogrel (all p < 0.001), the report at the European Society of Cardiology (ESC) 2020 virtual meeting.

At two years, the primary end point occurred in 120 of the 2968 patients (2.8 per 1000 patient years) in the ticagrelor group, 446 of 9280 (2.7 per 1000 patient years  patients in the clopidogrel group and 21 of 692 (1.8 per 1000 patient years) prasugrel group (p = 0.03).

For individual components of the primary outcome the rates for death at two years were 0.9, 1.3 and 0.5  per 100 patient years for ticagrelor, clopidogrel and prasugrel. Rates for MI were 1.7, 1.1 and 0.8 respectively, and rates of stroke were 0.3,0.3 and 0.1 respectively.

The incidence of major bleeding (BARC 3,4 or 5) at discharge was 0.2% in the ticagrelor group, 0.4% clopidogrel group and 0.1% in the prasugrel group (p=0.21).

The study authors said there had been few real world head-to-head studies of prasugrel compared to ticagrelor in combination with aspirin in patients with coronary artery disease and PCI. And notably there had been no large cohort studies of longer than 12 months.

“For the first time we have shown in a large cohort of patients treated by PCI for ACS or CAD significantly lower 2-year rates of death, myocardial infarction and stroke amongst patients who received prasugrel than among those who received either clopidogrel or ticagrelor,” they concluded.

The study investigators declared they had no conflict of interest.