Efficacy and safety of ticagrelor versus prasugrel not affected by eGFR in ACS patients: ISAR-REACT 5 trial

Germany: Results from ISAR-REACT 5 trial have shown that a reduction of estimated glomerular filtration rate (eGFR) is related to increased risk for ischemic and bleeding events in acute coronary syndrome (ACS) patients. However, the reduction had no significant impact on the relative safety and efficacy of ticagrelor versus prasugrel. The study was published in the journal JACC: Cardiovascular Interventions.

Prior to this study, there was no clarity on the outcomes of ticagrelor versus prasugrel in patients with ACS according to eGFR. Jochen Wöhrle, Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany, and colleagues therefore aimed to assess the safety and efficacy of ticagrelor versus prasugrel for patients with ACS according to their eGFRs. 

The study included 4,012 patients who were then categorized into three groups: low eGFR (<60 mL/min/1.73 m2), intermediate eGFR (≥60 and <90 mL/min/1.73 m2), and high eGFR (≥90 mL/min/1.73 m2). The primary endpoint was a composite of all-cause death, myocardial infarction, and stroke; the secondary safety endpoint was Bleeding Academic Research Consortium types 3 to 5 bleeding, both at 1 year.