Ticagrelor vs Prasugrel in a Contemporary Real-World Cohort Undergoing Percutaneous Coronary Intervention

Anoop N. Koshy, Gennaro Giustino, Samantha Sartori, Htoo Kyaw, Mayank Yadav, Zhongjie Zhang, Amit Hooda, Ali Farooq, Parasuram Krishnamoorthy, Joseph M. Sweeny, Sahil Khera, Gregory W. Serrao, Raman Sharma, Javed Suleman, George Dangas, Annapoorna S. Kini, Roxana Mehran, Samin K. Sharma

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Potent P2Y12 agents such as ticagrelor and prasugrel are increasingly utilized across the clinical spectrum of patients undergoing percutaneous coronary intervention (PCI). There is a paucity of data supporting their use in a patient population inclusive of both acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) patients. Objectives: The authors compared the efficacy and safety of ticagrelor and prasugrel in a real-world contemporary PCI cohort. Methods: Consecutive patients undergoing PCI between 2014 and 2019 discharged on either prasugrel or ticagrelor were included from the prospectively collected institutional PCI registry. Primary endpoint was the composite of death and myocardial infarction (MI), with secondary outcomes including rates of bleeding, stroke, and target vessel revascularization at 1 year. Results: Overall, 3,858 patients were included in the study (ticagrelor: n = 2,771; prasugrel: n = 1,087), and a majority (48.4%) underwent PCI in the context of CCS. Patients prescribed ticagrelor were more likely to be female, have a history of cerebrovascular disease, and have ACS presentation, while those receiving prasugrel were more likely to be White with a higher prevalence of prior revascularization. No difference in the risk of death or MI was noted across the groups (ticagrelor vs prasugrel: 3.3% vs 3.1%; HR: 0.88; 95% CI: 0.54-1.43; P = 0.59). Rates of target vessel revascularization were significantly lower in the ticagrelor cohort (9.3% vs 14.0%; adjusted HR: 0.71; 95% CI: 0.55-0.91; P = 0.007) with no differences in stroke or bleeding. The results were consistent in patients with CCS (HR: 0.84; 95% CI: 0.46-1.54) and ACS (HR: 1.18; 95% CI: 0.46-1.54), without evidence of interaction (P = 0.37), and confirmed across multivariable adjustment and propensity score stratification analysis. Conclusions: In this contemporary patient population undergoing PCI, prasugrel and ticagrelor were associated with similar 1-year efficacy and safety.

Original languageEnglish
Pages (from-to)2270-2280
Number of pages11
JournalJACC: Cardiovascular Interventions
Issue number22
StatePublished - 28 Nov 2022


  • acute coronary syndrome
  • antiplatelet therapy
  • chronic coronary syndrome
  • major adverse cardiovascular event(s)
  • percutaneous coronary intervention
  • stable ischemic heart disease


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