La Dra. Silvia Valbuena López repasa los resultados del estudio con ticagrelor y prasugrel en pacientes con síndrome coronario agudo, presentado en ESC Congress 2019.

1. Silvia Valbuena López
ISAR-REACT 5:
TICAGRELOR VS PRASUGREL
IN ACUTE CORONARY SYNDROMES
NEJM. September 1, 2019. DOI: 10.1056/NEJMoa1908973

2. Silvia Valbuena LópezISAR-REACT 5
BACKGROUND
• PLATO and TRITON-TIMI trials showed superiority of ticagrelor and prasugrel compared to
clopidogrel in ACS
• No trial to date has directly evaluated both drugs
NON-STEMI STEMI

3. Silvia Valbuena LópezISAR-REACT 5
AIM  head to head comparison of a Ticagrelor vs Prasugrel-based
strategy in ACS patients with/without ST-elevation
HYPOTHESIS  Ticagrelor will be superior to Prasugrel (expected
incidence of primary endpoint 10% vs 12,9%, RRR 22,5%)

4. Silvia Valbuena LópezISAR-REACT 5
TRIAL DESIGN
• Investigator-led (DZHK München)
• Randomized, multicenter, open-label
• Outcomes asigned by blinded evaluator
• Inclusion  ACS with planned invasive strategy
• Endpoints:
- Primary endpoint  death + MI + stroke (12 months)
- Secondary endpoint  death, MI, stroke, stent thrombosis (definite or probable)
- Safety endpoint  Bleeding BARC 3-5
• Ticagrelor and Prasugrel doses as per guidelines  Prasugrel administered after
angiography in N-STEMI

5. Silvia Valbuena LópezISAR-REACT 5
STUDY FLOW

6. Silvia Valbuena LópezISAR-REACT 5
BASELINE CHARACTERISTICS

7. Silvia Valbuena LópezISAR-REACT 5
RESULTS

8. Silvia Valbuena LópezISAR-REACT 5
RESULTS

9. Silvia Valbuena LópezISAR-REACT 5
RESULTS

10. Silvia Valbuena LópezISAR-REACT 5
RESULTS

11. Silvia Valbuena LópezISAR-REACT 5
LIMITATIONS
• Open-label
• Comparison of 2 drugs and 2 treatment strategies

12. Silvia Valbuena LópezISAR-REACT 5
CONCLUSIONS
In patients with ACS with or without ST-elevation, Prasugrel
compared to Ticagrelor significantly reduced the composite
endpoint of death, MI or stroke