Intracoronary Stenting and Antithrombotic Regimen 5 - ISAR-REACT 5


Intracoronary Stenting and Antithrombotic Regimen 5 - ISAR-REACT 5

Author: Anthony A. Bavry, MD, MPH, FACC

· Summary Reviewer: Deepak L. Bhatt, MD, MPH, FACC

Trial Sponsor: German Center for Cardiovascular Research, Deutsches Herzzentrum Muchen

Description:

The goal of the trial was to evaluate ticagrelor compared with prasugrel among patients with an acute coronary syndrome undergoing planned coronary angiography.

Study Design

  • Randomized

  • Parallel

  • Open-label

Patients with an acute coronary syndrome undergoing planned early invasive therapy were randomized to ticagrelor (n = 2,012) versus prasugrel (n = 2,006)

Patients randomized to ticagrelor received a loading dose of 180 mg as soon as possible and were continued on 90 mg twice daily.

Patients randomized to prasugrel received a loading dose of 60 mg as soon as possible for ST-segment elevation myocardial infarction (STEMI) and after coronary angiography/before percutaneous coronary intervention (PCI) for non-STEMI (NSTEMI)/unstable angina patients. Patients were continued on 10 mg daily (5 mg daily for those ≥75 years or weight <60 kg).

Patients who were treated conservatively after coronary angiography were maintained on their assigned study drug.

 • Total number of enrollees: 4,018

 •  Duration of follow-up: 1 year

 •  Mean patient age: 65 years

 •  Percentage female: 24%

 •  Percentage with diabetes: 23%

Inclusion criteria:

 • Patients ≥18 years of age admitted with an acute coronary syndrome (STEMI, NSTEMI, and unstable angina)

 • Scheduled coronary angiography

Exclusion criteria:

 • History of stroke, transient ischemic attack, or intracranial hemorrhage

 • Known intracranial neoplasm, arteriovenous malformation, or aneurysm