Efficacy and Safety of Clopidogrel, Prasugrel and Ticagrelor in ACS Patients Treated with PCI: A Propensity Score Analysis of the RENAMI and BleeMACS Registries.

Autor: Peyracchia M; Division of Cardiology, Department of Medical Sciences, University of Torino, Turin, Italy. peyracchia@gmail.com., Saglietto A; Division of Cardiology, Department of Medical Sciences, University of Torino, Turin, Italy., Biolè C; Division of Cardiology, Department of Medical Sciences, University of Torino, Turin, Italy., Raposeiras-Roubin S; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Abu-Assi E; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Kinnaird T; Cardiology Department, University Hospital of Wales, Cardiff, UK., Ariza-Solé A; Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain., Liebetrau C; Kerckhoff Heart and Thorax Center, Frankfurt, Germany., Manzano-Fernández S; Department of Cardiology, University Hospital Virgen Arrtixaca, Murcia, Spain., Boccuzzi G; Department of Cardiology, S.G. Bosco Hospital, Turin, Italy., Henriques JPS; Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands., Wilton SB; Cardiovascular Institute of Alberta, Calgary, Canada., Velicki L; Institute of Cardiovascular Diseases, Vojvodina, Serbia., Xanthopoulou I; University Patras Hospital, Athens, Greece., Correia L; Hospital Sao Rafael, Salvador, Brazil., Rognoni A; Catheterization Laboratory, Maggiore della Carità Hospital, Novara, Italy., Fabrizio U; Department of Cardiology, S.G. Bosco Hospital, Turin, Italy., Nuñez-Gil I; San Carlos Hospital, Madrid, Spain., Montabone A; Department of Cardiology, S.G. Bosco Hospital, Turin, Italy., Taha S; Department of Cardiology, Faculty of Medicine, Assiut University, Asyut, Egypt., Fujii T; Tokai University School of Medicine, Tokyo, Japan., Durante A; U.O. Cardiologia, Ospedale Valduce, Como, Italy., Gili S; Division of Cardiology, Universitaspital, Zurich, Switzerland., Magnani G; Division of Cardiology, Universitaspital, Zurich, Switzerland., Autelli M; Division of Cardiology, Department of Medical Sciences, University of Torino, Turin, Italy., Grosso A; Division of Cardiology, Department of Medical Sciences, University of Torino, Turin, Italy., Kawaji T; University Graduate School of Medicine, Kyoto, Japan., Blanco PF; Department of Cardiology, University Hospital Virgen Arrtixaca, Murcia, Spain., Garay A; Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain., Quadri G; Interventional Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli (Turin), Turin, Italy., Queija BC; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Huczek Z; University Clinical Hospital, Warsaw, Poland., Paz RC; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., González-Juanatey JR; University Clinical Hospital, Santiago de Compostela, Spain., Fernández MC; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Nie SP; Institute of Heart Lung and Blood vessel disease, Beijing, China., D'Amico M; Division of Cardiology, Department of Medical Sciences, University of Torino, Turin, Italy., Pousa IM; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Kawashiri MA; University Graduate School of Medicine, Kanazaw, Japan., Gallo D; PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy., Morbiducci U; PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy., Dominguez-Rodriguez A; Servicio de Cardiologìa, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain., Lopez-Cuenca A; Department of Cardiology, University Hospital Virgen Arrtixaca, Murcia, Spain., Cequier A; Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain., Alexopoulos D; University Patras Hospital, Athens, Greece., Iñiguez-Romo A; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Grossomarra W; Division of Cardiology, Department of Medical Sciences, University of Torino, Turin, Italy., Usmiani T; Division of Cardiology, Department of Medical Sciences, University of Torino, Turin, Italy., Rinaldi M; Division of Cardiology, Department of Medical Sciences, University of Torino, Turin, Italy., D'Ascenzo F; Division of Cardiology, Department of Medical Sciences, University of Torino, Turin, Italy.
Jazyk: angličtina
Zdroj: American journal of cardiovascular drugs : drugs, devices, and other interventions [Am J Cardiovasc Drugs] 2020 Jun; Vol. 20 (3), pp. 259-269.
DOI: 10.1007/s40256-019-00373-1
Abstrakt: 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.
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.
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.
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.
Databáze: MEDLINE
Externí odkaz: