Table 2

Summary of secondary prevention for acute coronary syndromes in major trials and subanalyses

DrugConservative managementPercutaneous coronary interventionST segment elevation myocardial infarctionParticularities
AspirinNo difference between standard dose (75–100 mg daily) and high dose (300–325 mg daily) with regards to a composite of cardiovascular death, myocardial infarction or stroke
ClopidogrelNo difference between high dose (600 mg loading dose followed by 150 mg daily for 1 week) versus standard dose (300 mg loading dose followed by 75 mg daily) with regards to a composite of cardiovascular death, myocardial infarction or stroke(+)Reduction of composite end point of cardiovascular death, myocardial infarction or stroke with high dose (600 mg loading dose followed by 150 mg daily for 1 week)No difference between high dose (600 mg loading dose followed by 150 mg daily for 1 week) versus standard dose (300 mg loading dose followed by 75 mg daily) with regards to a composite of cardiovascular death, myocardial infarction or stroke(−)High interindividual variability of platelet inhibition; no impact of tailored therapy by platelet function assays and genetic testing
PrasugrelSimilar efficacy as compared with clopidogrel with regards to a composite of cardiovascular death, myocardial infarction or stroke;
(+)Lower risk of recurrent ischaemic events as compared with clopidogrel
No excess in bleeding events as compared with clopidogrel
(+)Reduction of composite of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke as compared with clopidogrel
(+)Lower rates of stent thrombosis and urgent target-vessel revascularisations as compared with clopidogrel
(−)Increase in major, life-threatening and fatal bleeding as compared with clopidogrel
(+)Reduction of composite of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke as compared with clopidogrel
(+)Lower rates of stent thrombosis and myocardial infarction as compared with clopidogrel
No excess in bleeding events as compared with clopidogrel
(+)Greater net clinical benefit among patients with diabetes than for patients without diabetes:effective reduction of myocardial infarction, no excessive risk of major bleeding as compared with clopidogrel
(−)No benefit or even harm in patients ≥75 years, <60 kg, or a history of cerebrovascular events
Ticagrelor(+)Reduction of composite of vascular death, myocardial infarction or stroke as compared with clopidogrel
(+)Reduction in mortality as compared with clopidogrel
(−)Numerically higher rates of total major bleedings and non-CABG- related major bleedings
with ticagrelor than with clopidogrel.
(+)Reduction of composite of vascular death, myocardial infarction or stroke as compared with clopidogrel
(+)Reduction in mortality and myocardial infarction as compared with clopidogrel
No excess of major bleeding as compared with clopidogrel; higher rate of non-CABG- related major bleedings, including fatal intracranial bleeding
(+)Reduction of composite of vascular death, myocardial infarction or stroke as compared with clopidogrel
(+)Reduction of mortality, myocardial infarction and stent thrombosis as compared with clopidogrel
(−)Increased risk of stroke as compared with clopidogrel
(−)Non-superior efficacy as clopidogrel among patients with unstable angina
(−)Adverse effects: dyspnoea, ventricular pauses