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Ticagrelor vs Clopidogrel in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: Insights From a Single Institution Registry
Dual-antiplatelet therapy is recommended for all patients with acute coronary syndromes (ACS), regardless of performance of revascularization. Ticagrelor (T) was shown to be superior to clopidogrel (C) in a large, randomized clinical trial, but data from real-world practice are lacking. We identifie...
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| Published in: | The Journal of invasive cardiology 2019-08, Vol.31 (8), p.235-238 |
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| container_title | The Journal of invasive cardiology |
| container_volume | 31 |
| creator | Brener, Sorin J Alapati, Venkatesh Benson, Max M Chan, Doris Cunn, Gregory Khan, Saadat Kutkut, Issa Narayanan, C Arun O'Laughlin, John P Sacchi, Terrence J |
| description | Dual-antiplatelet therapy is recommended for all patients with acute coronary syndromes (ACS), regardless of performance of revascularization. Ticagrelor (T) was shown to be superior to clopidogrel (C) in a large, randomized clinical trial, but data from real-world practice are lacking. We identified ACS patients from our institutional registry who underwent percutaneous coronary intervention and received one of the two drugs at hospital discharge based on physician preference. Among 1439 patients, there were 774 patients (53.8%) in the C group and 665 patients (46.2%) in the T group. T and C patients were similar except for a higher incidence of ST-elevation myocardial infarction (MI) and lower frequency of prior MI in the T group (P |
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Ticagrelor (T) was shown to be superior to clopidogrel (C) in a large, randomized clinical trial, but data from real-world practice are lacking. We identified ACS patients from our institutional registry who underwent percutaneous coronary intervention and received one of the two drugs at hospital discharge based on physician preference. Among 1439 patients, there were 774 patients (53.8%) in the C group and 665 patients (46.2%) in the T group. T and C patients were similar except for a higher incidence of ST-elevation myocardial infarction (MI) and lower frequency of prior MI in the T group (P<.05 for both). The primary endpoint - 1-year all-cause death - occurred in 58 C patients and 48 T patients (6.9% vs 7.9%, respectively; P=.42). Sixty percent of these deaths (n = 62; 31 C and 31 T) were considered cardiovascular in nature based on chart review. By multivariable logistic regression model, only dialysis (hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.50-4.64; P=.01), age (HR, 1.83; 95% CI, 1.49-2.24 per 10 years; P<.001), and prior heart failure (HR, 1.78; 95% CI, 1.12-2.82; P=.02) were independent predictors of 1-year death. Treatment with T was not a predictor of death (HR, 1.21; 95% CI, 0.81-1.82; P=.35) or cardiovascular death (HR, 1.18; 95% CI, 0.72-1.94; P=.52). Landmark analysis from day 10 showed similar results (HR, 1.13; 95% CI, 0.71-1.84; P=.59). Thus, we conclude that C and T have similar rates of 1-year all-cause mortality, which is predominantly affected by age, end-stage renal disease, and pre-existing heart failure.</description><identifier>EISSN: 1557-2501</identifier><identifier>PMID: 31303603</identifier><language>eng</language><publisher>United States</publisher><subject>Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - mortality ; Acute Coronary Syndrome - therapy ; Aged ; Cause of Death - trends ; Clopidogrel - administration & dosage ; Coronary Angiography ; Dose-Response Relationship, Drug ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors - administration & dosage ; Postoperative Complications - epidemiology ; Postoperative Complications - prevention & control ; Purinergic P2Y Receptor Antagonists - administration & dosage ; Registries ; Retrospective Studies ; Survival Rate - trends ; Ticagrelor - administration & dosage ; Treatment Outcome ; United States - epidemiology</subject><ispartof>The Journal of invasive cardiology, 2019-08, Vol.31 (8), p.235-238</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31303603$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brener, Sorin J</creatorcontrib><creatorcontrib>Alapati, Venkatesh</creatorcontrib><creatorcontrib>Benson, Max M</creatorcontrib><creatorcontrib>Chan, Doris</creatorcontrib><creatorcontrib>Cunn, Gregory</creatorcontrib><creatorcontrib>Khan, Saadat</creatorcontrib><creatorcontrib>Kutkut, Issa</creatorcontrib><creatorcontrib>Narayanan, C Arun</creatorcontrib><creatorcontrib>O'Laughlin, John P</creatorcontrib><creatorcontrib>Sacchi, Terrence J</creatorcontrib><title>Ticagrelor vs Clopidogrel in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: Insights From a Single Institution Registry</title><title>The Journal of invasive cardiology</title><addtitle>J Invasive Cardiol</addtitle><description>Dual-antiplatelet therapy is recommended for all patients with acute coronary syndromes (ACS), regardless of performance of revascularization. Ticagrelor (T) was shown to be superior to clopidogrel (C) in a large, randomized clinical trial, but data from real-world practice are lacking. We identified ACS patients from our institutional registry who underwent percutaneous coronary intervention and received one of the two drugs at hospital discharge based on physician preference. Among 1439 patients, there were 774 patients (53.8%) in the C group and 665 patients (46.2%) in the T group. T and C patients were similar except for a higher incidence of ST-elevation myocardial infarction (MI) and lower frequency of prior MI in the T group (P<.05 for both). The primary endpoint - 1-year all-cause death - occurred in 58 C patients and 48 T patients (6.9% vs 7.9%, respectively; P=.42). Sixty percent of these deaths (n = 62; 31 C and 31 T) were considered cardiovascular in nature based on chart review. By multivariable logistic regression model, only dialysis (hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.50-4.64; P=.01), age (HR, 1.83; 95% CI, 1.49-2.24 per 10 years; P<.001), and prior heart failure (HR, 1.78; 95% CI, 1.12-2.82; P=.02) were independent predictors of 1-year death. Treatment with T was not a predictor of death (HR, 1.21; 95% CI, 0.81-1.82; P=.35) or cardiovascular death (HR, 1.18; 95% CI, 0.72-1.94; P=.52). Landmark analysis from day 10 showed similar results (HR, 1.13; 95% CI, 0.71-1.84; P=.59). Thus, we conclude that C and T have similar rates of 1-year all-cause mortality, which is predominantly affected by age, end-stage renal disease, and pre-existing heart failure.</description><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - mortality</subject><subject>Acute Coronary Syndrome - therapy</subject><subject>Aged</subject><subject>Cause of Death - trends</subject><subject>Clopidogrel - administration & dosage</subject><subject>Coronary Angiography</subject><subject>Dose-Response Relationship, Drug</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Percutaneous Coronary Intervention</subject><subject>Platelet Aggregation Inhibitors - administration & dosage</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Purinergic P2Y Receptor Antagonists - administration & dosage</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Survival Rate - trends</subject><subject>Ticagrelor - administration & dosage</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><issn>1557-2501</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNpFkF1LwzAUhosgbk7_guTSm0I-mrbxbhSng4HiNrwsbXrWRdqkJulgf8bfasYmXh3Oy_M-cM5VNCWcZzHlmEyiW-e-MKaECXITTRhhmKWYTaOfjZJVa6EzFh0cKjozqMacAqQ0eq-8Au0d-lR-j-Zy9IAKY42u7BGtj7qxpgeHtroB2xqlW_QONlCVBjO6f3SpPdhDMCmjn8LmVLsP1kWoowqtQ7GDU-yVH08M-oBWOW-Pd9H1ruoc3F_mLNounjfFa7x6e1kW81U8UEJ8LNKMYlY3GTRE4DonXBCW81RKyFMMIpc7ucsyqAnLasGoqGshMREswTxNuGCz6PHsHaz5HsH5sldOQtedLykp5UFKsyQJ6MMFHesemnKwqg83ln8_Zb8J_HTm</recordid><startdate>20190801</startdate><enddate>20190801</enddate><creator>Brener, Sorin J</creator><creator>Alapati, Venkatesh</creator><creator>Benson, Max M</creator><creator>Chan, Doris</creator><creator>Cunn, Gregory</creator><creator>Khan, Saadat</creator><creator>Kutkut, Issa</creator><creator>Narayanan, C Arun</creator><creator>O'Laughlin, John P</creator><creator>Sacchi, Terrence J</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20190801</creationdate><title>Ticagrelor vs Clopidogrel in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: Insights From a Single Institution Registry</title><author>Brener, Sorin J ; Alapati, Venkatesh ; Benson, Max M ; Chan, Doris ; Cunn, Gregory ; Khan, Saadat ; Kutkut, Issa ; Narayanan, C Arun ; O'Laughlin, John P ; Sacchi, Terrence J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p211t-967203bd7ed190b815913856cce860e98cfcf77eb137b9329bb9c019340564593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - mortality</topic><topic>Acute Coronary Syndrome - therapy</topic><topic>Aged</topic><topic>Cause of Death - trends</topic><topic>Clopidogrel - administration & dosage</topic><topic>Coronary Angiography</topic><topic>Dose-Response Relationship, Drug</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Percutaneous Coronary Intervention</topic><topic>Platelet Aggregation Inhibitors - administration & dosage</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Purinergic P2Y Receptor Antagonists - administration & dosage</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Survival Rate - trends</topic><topic>Ticagrelor - administration & dosage</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brener, Sorin J</creatorcontrib><creatorcontrib>Alapati, Venkatesh</creatorcontrib><creatorcontrib>Benson, Max M</creatorcontrib><creatorcontrib>Chan, Doris</creatorcontrib><creatorcontrib>Cunn, Gregory</creatorcontrib><creatorcontrib>Khan, Saadat</creatorcontrib><creatorcontrib>Kutkut, Issa</creatorcontrib><creatorcontrib>Narayanan, C Arun</creatorcontrib><creatorcontrib>O'Laughlin, John P</creatorcontrib><creatorcontrib>Sacchi, Terrence J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of invasive cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brener, Sorin J</au><au>Alapati, Venkatesh</au><au>Benson, Max M</au><au>Chan, Doris</au><au>Cunn, Gregory</au><au>Khan, Saadat</au><au>Kutkut, Issa</au><au>Narayanan, C Arun</au><au>O'Laughlin, John P</au><au>Sacchi, Terrence J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ticagrelor vs Clopidogrel in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: Insights From a Single Institution Registry</atitle><jtitle>The Journal of invasive cardiology</jtitle><addtitle>J Invasive Cardiol</addtitle><date>2019-08-01</date><risdate>2019</risdate><volume>31</volume><issue>8</issue><spage>235</spage><epage>238</epage><pages>235-238</pages><eissn>1557-2501</eissn><abstract>Dual-antiplatelet therapy is recommended for all patients with acute coronary syndromes (ACS), regardless of performance of revascularization. Ticagrelor (T) was shown to be superior to clopidogrel (C) in a large, randomized clinical trial, but data from real-world practice are lacking. We identified ACS patients from our institutional registry who underwent percutaneous coronary intervention and received one of the two drugs at hospital discharge based on physician preference. Among 1439 patients, there were 774 patients (53.8%) in the C group and 665 patients (46.2%) in the T group. T and C patients were similar except for a higher incidence of ST-elevation myocardial infarction (MI) and lower frequency of prior MI in the T group (P<.05 for both). The primary endpoint - 1-year all-cause death - occurred in 58 C patients and 48 T patients (6.9% vs 7.9%, respectively; P=.42). Sixty percent of these deaths (n = 62; 31 C and 31 T) were considered cardiovascular in nature based on chart review. By multivariable logistic regression model, only dialysis (hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.50-4.64; P=.01), age (HR, 1.83; 95% CI, 1.49-2.24 per 10 years; P<.001), and prior heart failure (HR, 1.78; 95% CI, 1.12-2.82; P=.02) were independent predictors of 1-year death. Treatment with T was not a predictor of death (HR, 1.21; 95% CI, 0.81-1.82; P=.35) or cardiovascular death (HR, 1.18; 95% CI, 0.72-1.94; P=.52). Landmark analysis from day 10 showed similar results (HR, 1.13; 95% CI, 0.71-1.84; P=.59). Thus, we conclude that C and T have similar rates of 1-year all-cause mortality, which is predominantly affected by age, end-stage renal disease, and pre-existing heart failure.</abstract><cop>United States</cop><pmid>31303603</pmid><tpages>4</tpages></addata></record> |
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| subjects | Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - mortality Acute Coronary Syndrome - therapy Aged Cause of Death - trends Clopidogrel - administration & dosage Coronary Angiography Dose-Response Relationship, Drug Female Follow-Up Studies Humans Incidence Male Middle Aged Percutaneous Coronary Intervention Platelet Aggregation Inhibitors - administration & dosage Postoperative Complications - epidemiology Postoperative Complications - prevention & control Purinergic P2Y Receptor Antagonists - administration & dosage Registries Retrospective Studies Survival Rate - trends Ticagrelor - administration & dosage Treatment Outcome United States - epidemiology |
| title | Ticagrelor vs Clopidogrel in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: Insights From a Single Institution Registry |
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