Supplementary Material for: Ticagrelor versus Prasugrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention - analysis from the Acute Coronary Syndrome Israeli Survey (ACSIS)

Introduction: We aimed to compare the outcomes of ACS (acute coronary syndrome) patients undergoing in-hospital PCI (percutaneous coronary intervention) treated with prasugrel versus ticagrelor. Methods: Among 7,233 patients enrolled to the ACSIS (Acute Coronary Syndrome Israeli Survey) between 2010 and 2018, we identified 1126 eligible patients treated with prasugrel and 817 with ticagrelor. Comparison between the groups was preformed separately in ST-elevation myocardial infarction (STEMI) patients, propensity score matched (PSM) STEMI patients, and non-ST-elevation ACS (NSTE-ACS) patients. Results: In-hospital complication rates, including rates of stent thrombosis, were not significantly different between groups. In PSM STEMI patients, 30-day re-hospitalization rate (p <0.05), 30-day MACE (the composite of death, MI, stroke and urgent revascularization; p=0.006), and 1-year mortality rates (p = 0.08) were higher in the ticagrelor group compared to the prasugrel group; In NSTE-ACS patients, outcomes were not associated with drug choice. In cox regression analysis applied on the entire cohort, prasugrel was associated with lower 1-year mortality in STEMI patient but not in NSTE-ACS patients (p for interaction 0.03). Conclusions: Compared to ticagrelor, prasugrel was associated with superior clinical outcomes in STEMI patients, but not in NSTE-ACS patients.

引言：本研究旨在比较接受院内经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）的急性冠脉综合征（acute coronary syndrome, ACS）患者，分别使用普拉格雷（prasugrel）与替格瑞洛（ticagrelor）治疗后的临床结局。
方法：2010至2018年间，共7233名患者纳入以色列急性冠脉综合征调查（Acute Coronary Syndrome Israeli Survey, ACSIS）队列，其中1126例符合入组标准的患者接受普拉格雷治疗，817例接受替格瑞洛治疗。本研究分别在ST段抬高型心肌梗死（ST-elevation myocardial infarction, STEMI）患者、倾向得分匹配（propensity score matched, PSM）STEMI患者以及非ST段抬高型ACS（non-ST-elevation ACS, NSTE-ACS）患者中，对两组的临床结局进行比较分析。
结果：两组的院内并发症发生率（包括支架血栓形成发生率）均无显著统计学差异。在倾向得分匹配的STEMI患者中，与普拉格雷组相比，替格瑞洛组的30天再住院率（p<0.05）、30天主要不良心血管事件（MACE，复合终点为死亡、心肌梗死、卒中及紧急血运重建；p=0.006）以及1年死亡率（p=0.08）均更高；在NSTE-ACS患者中，临床结局与药物选择无显著关联。对全队列开展Cox回归分析显示，普拉格雷与STEMI患者更低的1年死亡率相关，但在NSTE-ACS患者中未观察到此关联（交互作用p值为0.03）。
结论：与替格瑞洛相比，普拉格雷可使STEMI患者获得更优的临床结局，但对NSTE-ACS患者无此获益。