Outcomes in patients after myocardial infarction similar to those of the PEGASUS‐TIMI 54 trial: A cohort study in the French national claims database

• Published in: British journal of clinical pharmacology 2017-09, Vol.83 (9), p.2056-2065
• Main Authors: Blin, Patrick, Dureau‐Pournin, Caroline, Lassalle, Régis, Jové, Jérémy, Thomas‐Delecourt, Florence, Droz‐Perroteau, Cécile, Danchin, Nicolas, Moore, Nicholas
• Format: Article
• Language: English
• Subjects: Aged; Anticoagulants - therapeutic use; coronary disease; Databases, Factual; Diabetes Complications - drug therapy; epidemiology; Female; France; haemorrhage; Hemorrhage - chemically induced; Hemorrhage - complications; Hospitalization - statistics & numerical data; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - drug therapy; Male; myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Pharmacoepidemiology; Platelet Aggregation Inhibitors - therapeutic use; secondary prevention; stroke; Time Factors; Treatment Outcome
• ISSN: 0306-5251; 1365-2125
• DOI: 10.1111/bcp.13291

Aims The present study aims to describe real‐life outcomes in stable patients after‐myocardial infarction (MI) similar to those in the PEGASUS‐TIMI 54 trial (PEGASUS), which found long‐term benefits of ticagrelor in patients with a history of MI. Methods One‐year event‐free post‐MI patients were identified in the French claims database representative 1/97 sample (2005–2010) and followed for up to 3 years. A PEGASUS‐like (PL) population included patients with age ≥ 65 years, or age ≥ 50 and diabetes, renal dysfunction or prior MI, without stroke, end‐stage renal failure or oral anticoagulation. Outcomes were: a composite of all‐cause death or hospital admission for MI or stroke; individual events; major bleeding. Results There were 1585 post‐MI patients totalling 3926 person–years including 865 PL patients (2114 PY); 68% were male; mean age was 66 (standard deviation 15) in post‐MI, 74 (10) in PL. Outcomes per 100 person–years [95% confidence interval] were, respectively, in post‐MI and PL 6.3 [5.6–7.1] and 7.8 [6.7–8.9] for the composite outcome; 5.1 [4.4–5.8] and 6.5 [5.5–7.6] for death; 1.0 [0.7–1.3] and 1.0 [0.6–1.4] for MI; 0.6 [0.4–0.9] and 0.9 [0.5–1.2] for stroke; 1.3 [0.9–1.6] and 1.4 [0.9–1.9] for major bleeding. Event rates were stable over the 3 study years. Placebo patients in the PEGASUS‐TIMI54 Study were younger, more often male and had lower event rates, especially for all‐cause death and major bleeding. Conclusions Patients selected using the criteria described in PEGASUS were older with more comorbidities, resulting in higher all‐cause death and bleeding rates, but similar MI recurrence rates.