{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T12:01:29Z","timestamp":1784635289093,"version":"3.55.0"},"reference-count":26,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Due to inconsistent evidence regarding oral P2Y12 inhibitors in patients with ACS, we critically assessed the results of the PL-ACS registry in comparison to the results of randomized clinical trials (RCTs). Methods: Publications describing 8 RCTs including 40,724 patients with ACS met the inclusion criteria and were compared with the PL-ACS registry report including 15933 patients after propensity score matching. Results: The PL-ACS registry findings were directionally consistent with randomized evidence suggesting better ischemic outcomes with prasugrel- or ticagrelor-based DAPT compared with clopidogrel-based DAPT; however, because of the observational design, propensity score matching, regional availability of selected endpoints, and differences in bleeding ascertainment, these findings should be interpreted as complementary rather than confirmatory. On the other hand, the results of the direct comparison of prasugrel and ticagrelor in the PL-ACS registry, while consistent with the results of the meta-analysis, markedly diverge from the results of the ISAR-REACT 5 study with regard to most efficacy and safety endpoints. Conclusions: Randomized evidence and complementary PL-ACS registry data support better ischemic outcomes with prasugrel- or ticagrelor-based DAPT compared with clopidogrel-based DAPT in ACS, although differences in bleeding risk and the observational nature of registry data require cautious interpretation. Current evidence does not establish definitive superiority of either prasugrel or ticagrelor, as direct randomized evidence remains limited and not fully concordant with registry findings.<\/jats:p>","DOI":"10.3390\/jcm15145714","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T10:35:52Z","timestamp":1784630152000},"page":"5714","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clopidogrel Versus Prasugrel Versus Ticagrelor in Patients with Acute Coronary Syndrome: New Insights from a Large Registry Compared to Randomized Clinical Trials\u2014A Structured Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2309-2369","authenticated-orcid":false,"given":"Julia","family":"Umi\u0144ska","sequence":"first","affiliation":[{"name":"Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Bia\u0142oszy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Faculty of Public Health, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3410-7407","authenticated-orcid":false,"given":"Micha\u0142","family":"Skrzypek","sequence":"additional","affiliation":[{"name":"Bydgoszcz University of Science and Technology, 85-796 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariusz","family":"G\u0105sior","sequence":"additional","affiliation":[{"name":"3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland"},{"name":"Silesian Center for Heart Diseases, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9719-0987","authenticated-orcid":false,"given":"Piotr","family":"Adamski","sequence":"additional","affiliation":[{"name":"Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8305-8130","authenticated-orcid":false,"given":"Robert","family":"Gajda","sequence":"additional","affiliation":[{"name":"Moderndical Technologies Center, 87-100 Torun, Poland"},{"name":"Gajda-Med District Hospital, 06-102 Pultusk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Gurbel","sequence":"additional","affiliation":[{"name":"Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital, Baltimore, MD 21215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6175-2191","authenticated-orcid":false,"given":"Klaudyna","family":"Grzelakowska","sequence":"additional","affiliation":[{"name":"Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1196-5283","authenticated-orcid":false,"given":"Tomasz","family":"Dominiak","sequence":"additional","affiliation":[{"name":"Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3880-5325","authenticated-orcid":false,"given":"Bartosz","family":"Hudzik","sequence":"additional","affiliation":[{"name":"3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland"},{"name":"Department of Cardiovascular Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kornelia","family":"K\u0119dziora-Kornatowska","sequence":"additional","affiliation":[{"name":"Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udaya","family":"Tantry","sequence":"additional","affiliation":[{"name":"Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital, Baltimore, MD 21215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Specchia","sequence":"additional","affiliation":[{"name":"University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0973-5455","authenticated-orcid":false,"given":"\u0141ukasz","family":"Szarpak","sequence":"additional","affiliation":[{"name":"Institute of Medical Science, Collegium Medicum, The John Paul II Catholic University of Lublin, 20-950 Lublin, Poland"},{"name":"Department of Clinical Research and Development, LUXMED Group, 02-678 Warsaw, Poland"},{"name":"Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Przemys\u0142aw","family":"Trzeciak","sequence":"additional","affiliation":[{"name":"Bydgoszcz University of Science and Technology, 85-796 Bydgoszcz, Poland"},{"name":"3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliano Pio","family":"Navarese","sequence":"additional","affiliation":[{"name":"Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland"},{"name":"Department of Life and Health Sciences, Link Campus University, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1056\/NEJMoa0706482","article-title":"Prasugrel versus clopidogrel in patients with acute coronary syndromes","volume":"357","author":"Wiviott","year":"2007","journal-title":"N. 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Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. 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