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Efficacy and Safety of Clopidogrel, Prasugrel and Ticagrelor in ACS Patients Treated with PCI: A Propensity Score Analysis of the RENAMI and BleeMACS Registries.
- Source :
-
American journal of cardiovascular drugs : drugs, devices, and other interventions [Am J Cardiovasc Drugs] 2020 Jun; Vol. 20 (3), pp. 259-269. - Publication Year :
- 2020
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Abstract
- Introduction: Real-life data comparing clopidogrel, prasugrel, and ticagrelor for unselected patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) are lacking, as are data for the temporal distribution of ischemic and bleeding risks.<br />Methods: A total of 19,825 patients were enrolled from the RENAMI and BleeMACS registries. Both were multicenter, retrospective, observational registries including the data and outcomes of consecutive patients with ACS who underwent primary PCI and were discharged with dual antiplatelet therapy (DAPT). We evaluated the long-term outcome stratified by the different antiplatelet agents.<br />Results: A total of 14,105 patients (71.2%) were treated with clopidogrel, 2364 patients (11.9%) with prasugrel and 3356 patients (16.9%) with ticagrelor. After propensity score matching, at 1 year, prasugrel reduced the incidence of net adverse clinical events (NACE; a composite endpoint of all-cause death, myocardial infarction [MI] and Bleeding Academic Research Consortium [BARC] 3-5 bleeding) (4.2% vs.7.6%, p = 0.002) and of major adverse cardiovascular events (MACE; a composite endpoint of death and MI) compared with clopidogrel (2.6% vs. 5.2%, p = 0.007). Ticagrelor decreased rates of MACE compared with clopidogrel (2.7% vs. 6.2%, p < 0.001), but not of NACE (6.6% vs. 8.7%, p = 0.07). Ticagrelor presented similar performance in terms of MACE compared with prasugrel (2.8% vs. 2.4%, p = 0.56), with a trend towards a reduction in MI (0.2% vs. 0.4%, p = 0.56), but with higher risk of BARC 3-5 bleedings (3.8% vs. 1.7%, p = 0.04). In the daily risk analysis, clopidogrel presented a binomial distribution with a peak of ischemic risk at 3 months, which decreased towards bleedings; prasugrel had a constant equivalence between opposite risks; and ticagrelor constantly reduced recurrent MIs despite higher risk of BARC 3-5 events.<br />Conclusion: In real life, ticagrelor is more effective in reducing ischemic events during the first year after ACS, despite an increased risk of major bleedings, while prasugrel assures a better balance between ischemic and bleeding recurrent events.
- Subjects :
- Acute Coronary Syndrome epidemiology
Europe epidemiology
Female
Humans
Male
Medication Therapy Management statistics & numerical data
Middle Aged
Mortality
Platelet Aggregation Inhibitors administration & dosage
Platelet Aggregation Inhibitors adverse effects
Platelet Aggregation Inhibitors pharmacokinetics
Registries statistics & numerical data
Risk Adjustment methods
Therapeutic Equivalency
Acute Coronary Syndrome surgery
Clopidogrel administration & dosage
Clopidogrel adverse effects
Clopidogrel pharmacokinetics
Hemorrhage chemically induced
Hemorrhage epidemiology
Myocardial Infarction epidemiology
Myocardial Infarction prevention & control
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention methods
Prasugrel Hydrochloride administration & dosage
Prasugrel Hydrochloride adverse effects
Prasugrel Hydrochloride pharmacokinetics
Ticagrelor administration & dosage
Ticagrelor adverse effects
Ticagrelor pharmacokinetics
Subjects
Details
- Language :
- English
- ISSN :
- 1179-187X
- Volume :
- 20
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- American journal of cardiovascular drugs : drugs, devices, and other interventions
- Publication Type :
- Academic Journal
- Accession number :
- 31586336
- Full Text :
- https://doi.org/10.1007/s40256-019-00373-1