Germany: ISAR-REACT 5 Trial Results

Results from the 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)
• 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.

Research Findings

• Patients with low eGFRs had a higher risk for the primary endpoint compared with patients with intermediate eGFRs (adjusted HR: 1.89) and those with high eGFRs (adjusted HR: 2.33).
• A risk excess for low eGFR was also observed for bleeding (adjusted HR: 1.55 vs intermediate eGFR; adjusted HR: 1.59 vs high eGFR).
• However, eGFR did not affect the relative efficacy and safety of ticagrelor versus prasugrel.
• In patients with low eGFR, the primary endpoint occurred in 20.5% with ticagrelor and in 14.7% with prasugrel (HR: 1.47); there was no significant difference in bleeding.

The researchers concluded, these results show that among patients with ACS, reduction of eGFR is associated with increased risk for ischemic and bleeding events but has no significant impact on the relative efficacy and safety of ticagrelor versus prasugrel.

Reference

The study titled, "Ticagrelor or Prasugrel in Patients With Acute Coronary Syndrome in Relation to Estimated Glomerular Filtration Rate," is published in the journal JACC: Cardiovascular Interventions.

DOI: https://www.sciencedirect.com/science/article/abs/pii/S193687982101219X