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Heart. 2018 Oct;104(20):1683-1690. doi: 10.1136/heartjnl-2017-312366. Epub 2018 Feb 2.

Association of different antiplatelet therapies with mortality after primary percutaneous coronary intervention.

Author information

1
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.
2
Department of Applied Mathematics, Liverpool John Moores University, Liverpool, UK.
3
Department of Cardiology, The Heart Hospital, University College London Hospitals, London, UK.
4
Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
5
Department of Cardiology, University Hospital of Wales, Cardiff, UK.
6
Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
7
Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK.
8
Barts Heart Centre, Queen Mary University, London, UK.
9
King's College Hospital, London, UK.
10
Academic Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, UK.
11
Department of cardiology, University Hospital Southampton, Faculty of Medicine, University of Southampton, Southampton, UK.
#
Contributed equally

Abstract

OBJECTIVES:

Prasugrel and ticagrelor both reduce ischaemic endpoints in high-risk acute coronary syndromes, compared with clopidogrel. However, comparative outcomes of these two newer drugs in the context of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) remains unclear. We sought to examine this question using the British Cardiovascular Interventional Society national database in patients undergoing primary PCI for STEMI.

METHODS:

Data from January 2007 to December 2014 were used to compare use of P2Y12 antiplatelet drugs in primary PCI in >89 000 patients. Statistical modelling, involving propensity matching, multivariate logistic regression (MLR) and proportional hazards modelling, was used to study the association of different antiplatelet drug use with all-cause mortality.

RESULTS:

In our main MLR analysis, prasugrel was associated with significantly lower mortality than clopidogrel at both 30 days (OR 0.87, 95% CI 0.78 to 0.97, P=0.014) and 1 year (OR 0.89, 95% CI 0.82 to 0.97, P=0.011) post PCI. Ticagrelor was not associated with any significant differences in mortality compared with clopidogrel at either 30 days (OR 1.07, 95% CI 0.95 to 1.21, P=0.237) or 1 year (OR 1.058, 95% CI 0.96 to 1.16, P=0.247). Finally, ticagrelor was associated with significantly higher mortality than prasugrel at both time points (30 days OR 1.22, 95% CI 1.03 to 1.44, P=0.020; 1 year OR 1.19 95% CI 1.04 to 1.35, P=0.01).

CONCLUSIONS:

In a cohort of over 89 000 patients undergoing primary PCI for STEMI in the UK, prasugrel is associated with a lower 30-day and 1-year mortality than clopidogrel and ticagrelor. Given that an adequately powered comparative randomised trial is unlikely to be performed, these data may have implications for routine care.

KEYWORDS:

antiplatelet drugs; clopidogrel; prasugrel; primary PCI; ticagrelor

PMID:
29437885
DOI:
10.1136/heartjnl-2017-312366
[Indexed for MEDLINE]

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