Comparison of prescription rates and clinical outcomes in acute coronary syndrome patients who underwent percutaneous coronary intervention using different P2Y12 inhibitors in a large observational study

• Published in: International journal of cardiology 2019-01, Vol.274, p.21-26
• Main Authors: Choe, Jeong Cheon, Cha, Kwang Soo, Ahn, Jinhee, Park, Jin Sup, Lee, Hye Won, Oh, Jun-Hyok, Choi, Jung Hyun, Lee, Han Cheol, Hong, Taek Jong, Jeong, Myung Ho
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Efficacy; P2Y12 inhibitor; Percutaneous coronary intervention; Safety
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2018.09.011

To compare the prescription rates, safety, and efficacy of contemporary P2Y12 inhibitors in acute coronary syndrome (ACS) patients following percutaneous coronary intervention (PCI). From 9684 ACS patients who underwent PCI in a nationwide, real-world registry, we compared prescription rates, bleeding, and major adverse cardiac events (MACEs: cardiac death, nonfatal myocardial infarction, or stroke) according to ticagrelor, prasugrel, or clopidogrel use. The prescription rates of ticagrelor, prasugrel, and clopidogrel were 15.2%, 11.7%, and 73.0%, respectively. In-hospital bleeding occurred in 565 (5.8%) patients, with 108 (7.3%), 80 (7.9%), and 377 (5.3%) patients using ticagrelor, prasugrel, and clopidogrel, respectively, with significantly higher incidence in ticagrelor (p = 0.008) and prasugrel (p = 0.026) users than in clopidogrel users. Ticagrelor and prasugrel were not different in terms of in-hospital bleeding (p = 0.159). MACEs occurred in 804 patients (8.3%), with 82 (5.6%), 69 (6.1%), and 653 (9.2%) patients in ticagrelor, prasugrel, and clopidogrel, respectively (median follow-up, 468 days). Ticagrelor (p = 0.001) and prasugrel (p = 0.001) were associated with fewer MACEs than clopidogrel; the difference between ticagrelor and prasugrel for fewer MACEs was nonsignificant (p = 0.235). In real-world ACS patients following PCI, ticagrelor and prasugrel were not prescribed at higher rates than clopidogrel, but were found to improve clinical outcomes, albeit they induced bleeding more frequently. No differences were observed in bleeding and outcomes in ticagrelor versus prasugrel. •Ticagrelor and prasugrel were used less often than clopidogrel.•Both drugs were associated with better major adverse cardiac events and increased risk of in-hospital bleeding.•Ticagrelor and prasugrel were not significantly different in in-hospital bleeding and MACEs.