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Original research
Prasugrel versus ticagrelor in patients with myocardial infarction undergoing percutaneous coronary intervention
  1. Dimitrios Venetsanos1,
  2. Erik Träff2,
  3. David Erlinge3,
  4. Emil Hagström4,5,
  5. Johan Nilsson6,
  6. Liyew Desta1,
  7. Bertil Lindahl4,
  8. Linda Mellbin1,
  9. Elmir Omerovic7,
  10. Karolina Elisabeth Szummer8,
  11. Sammy Zwackman2,
  12. Tomas Jernberg9,
  13. Joakim Alfredsson2
  1. 1Division of Cardiology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Karolinska Institutet Solna, Stockholm, Sweden
  2. 2Department of Cardiology and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University Linköping, Linkopings Universitet, Linkoping, Sweden
  3. 3Department of Cardiology, Lund University, Lund, Sweden
  4. 4Department of Medical Sciences, Uppsala University, Uppsala Universitet, Uppsala, Sweden
  5. 5Department of Medical Sciences, Cardiology, Uppsala Universitet, Uppsala, Sweden
  6. 6Department of Cardiology, Umeå University, Umea Universitet, Umea, Sweden
  7. 7Department of Cardiology, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden, Sahlgrenska Academy, Goteborg, Sweden
  8. 8Division of Cardiology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Karolinska Institutet Huddinge, Stockholm, Sweden
  9. 9Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
  1. Correspondence to Dr Dimitrios Venetsanos, Division of Cardiology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Karolinska Institutet Solna, Stockholm, Sweden; dimitrios.venetsanos{at}


Objective The comparative efficacy and safety of prasugrel and ticagrelor in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) remain unclear. We aimed to investigate the association of treatment with clinical outcomes.

Methods In the SWEDEHEART (Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies) registry, all patients with MI treated with PCI and discharged on prasugrel or ticagrelor from 2010 to 2016 were included. Outcomes were 1-year major adverse cardiac and cerebrovascular events (MACCE, death, MI or stroke), individual components and bleeding. Multivariable adjustment, inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to adjust for confounders.

Results We included 37 990 patients, 2073 in the prasugrel group and 35 917 in the ticagrelor group. Patients in the prasugrel group were younger, more often admitted with ST elevation MI and more likely to have diabetes. Six to twelve months after discharge, 20% of patients in each group discontinued the P2Y12 receptor inhibitor they received at discharge. The risk for MACCE did not significantly differ between prasugrel-treated and ticagrelor-treated patients (adjusted HR 1.03, 95% CI 0.86 to 1.24). We found no significant difference in the adjusted risk for death, recurrent MI or stroke alone between the two treatments. There was no significant difference in the risk for bleeding with prasugrel versus ticagrelor (2.5% vs 3.2%, adjusted HR 0.92, 95% CI 0.69 to 1.22). IPTW and PSM analyses confirmed the results.

Conclusion In patients with MI treated with PCI, prasugrel and ticagrelor were associated with similar efficacy and safety during 1-year follow-up.

  • acute coronary syndrome
  • percutaneous coronary intervention

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  • Contributors DV and JA were responsible for the conception of the work and statistical analysis. All authors have contributed to interpretation of data for the work and manuscript drafting. All authors have reviewed and approved the manuscript and are willing to attest to their qualification as authors and disclose potential conflicts of interest. All authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding SWEDEHEART is supported by the Swedish Heart-Lung Foundation.

  • Competing interests DV reports a grant from Boston Scientific, outside the submitted work. DE reports speaker fees from AstraZeneca and Bayer and serves in the advisor board for Bayer and Boehringer Ingelheim, outside the submitted work. EH reports grants and honoraria from Amgen, Sanofi, Bayer and NovoNordisk, outside the submitted work. LM reports consulting fees/lecture from AstraZeneca, Bayer, Boehringer Ingelheim Novartis, NovoNordisk, MSD, Sanofi and Amgen, outside the submitted work. EO reports institutional research grant from AstraZeneca and consulting fees from Novartis, MSD, AstraZeneca and Bayer, outside the submitted work. TJ reports research grants from MSD and Novartis, outside the submitted work. JA reports grants and lecture fees from AstraZeneca, Lilly, Pfizer, Bayer, Novartis and Boehringer Ingelheim, and serving on advisory board for AstraZeneca, Novartis and MSD, outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the regional ethics committee in Stockholm, Sweden (2015/332 32).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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