Ticagrelor is tops for post-ACS survival: network meta-analysis

  • Navarese EP & al.
  • Circulation
  • 29 May 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Ticagrelor is linked to reduced ischemic events and better survival vs clopidogrel in acute coronary syndrome (ACS), but may entail higher bleeding rates.
  • The authors of this network meta-analysis identified ticagrelor as “the most effective strategy” for preventing cardiovascular or all-cause mortality in ACS.

Why this matters

  • This analysis incorporates data from the latest randomized controlled trials (RCTs) of oral P2Y12 inhibitors for patients with ACS.

Key results

  • Median follow-up, 12 months; mean patient age, 63.7 years.
  • Included studies generally had low bias risk.
  • Risk vs clopidogrel (HRs; 95% CIs) for all-cause mortality (I2, 21.7%):
    • Ticagrelor: 0.83 (0.75-0.92).
    • Prasugrel: 0.92 (0.84-1.02).
  • The 3 did not differ in associations with noncardiovascular mortality risk.
  • Risk vs clopidogrel (HRs; 95% CIs) for major bleeding (I2, 35.3%):
    • Ticagrelor: 1.27 (1.04-1.55).
    • Prasugrel: 1.26 (1.01-1.56).
  • Risk vs clopidogrel (HRs; 95% CIs) for cardiovascular mortality (I2, 10.1%):
    • Ticagrelor: 0.82 (0.72-0.92).
    • Prasugrel: 0.90 (0.80-1.01).
  • No differences seen between prasugrel and ticagrelor for any of these outcomes.

Study design

  • Network meta-analysis of efficacy and safety outcomes in 12 RCTs (6 ticagrelor and 4 prasugrel vs clopidogrel; 2 compared all 3) with 52,816 patients.
  • Funding: None.

Limitations

  • No analysis of patient-level data.
  • Trial-specific definitions of major bleeding events.