Written by Mirjam Boros, Radcliffe Cardiology
The optimal dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) in high-risk patients with diabetes and multivessel disease remains a key clinical question. The TUXEDO-2 trial aimed to address this by directly comparing the efficacy and safety of ticagrelor versus prasugrel in this specific patient population.¹
Methodology
TUXEDO-2 was an investigator-initiated, prospective, open-label, multicentre, randomised clinical trial conducted across 66 sites in India. The study enrolled 1,800 patients with both diabetes and multivessel coronary artery disease who were undergoing PCI. Participants were randomised on a 1:1 basis to receive either ticagrelor or prasugrel, with both groups also receiving low-dose aspirin.
The primary outcome was a composite of death, nonfatal myocardial infarction (MI), stroke, or major bleeding, as defined by the Bleeding Academic Research Consortium (BARC), at 1-year follow-up. The trial was designed to test the noninferiority of ticagrelor compared with prasugrel.
Results
At the 1-year mark, the primary endpoint occurred in 16.6% of participants in the ticagrelor group compared to 14.2% in the prasugrel group. The absolute risk difference of 2.33 percentage points (95% CI, -2.07 to 6.74) did not meet the prespecified threshold for noninferiority (P=0.84).
Furthermore, the results showed numerically higher, though not statistically significant, rates of secondary outcomes in the ticagrelor arm. The composite of death, MI, or stroke occurred in 10.43% of ticagrelor patients versus 8.63% of prasugrel patients (P=0.30). Major bleeding was also numerically higher with ticagrelor, occurring in 8.41% of patients compared to 7.14% with prasugrel (P=0.19).
Interpretation
The findings suggest that ticagrelor did not demonstrate non-inferiority to prasugrel for the primary composite outcome at one year in the the study's patient population.¹ These results provide further evidence to guide the selection of P2Y12 inhibitors in this complex patient group.
References
1. Bangalore S, Sinha SK, Singh R, et al. Ticagrelor vs Prasugrel in Patients With Diabetes and Multivessel Coronary Artery Disease: The TUXEDO-2 Randomized Clinical Trial. _JAMA Cardiol._ Published online February 11, 2026. https://doi.org/10.1001/jamacardio.2025.5057
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