Effectiveness and safety of P2Y12inhibitors in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: a nationwide registry-based study
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Effectiveness and safety of P2Y12inhibitors in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention : a nationwide registry-based study. / Godtfredsen, Sissel J.; Kragholm, Kristian H.; Leutscher, Peter; Jorgensen, Steen Hylgaard; Christensen, Martin Kirk; Butt, Jawad H.; Gislason, Gunnar; Kober, Lars; Fosbol, Emil L.; Sessa, Maurizio; Bhatt, Deepak L.; Torp-Pedersen, Christian; Pareek, Manan.
In: European Heart Journal: Acute Cardiovascular Care, Vol. 11, No. 9, 2022, p. 697–705.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Effectiveness and safety of P2Y12inhibitors in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention
T2 - a nationwide registry-based study
AU - Godtfredsen, Sissel J.
AU - Kragholm, Kristian H.
AU - Leutscher, Peter
AU - Jorgensen, Steen Hylgaard
AU - Christensen, Martin Kirk
AU - Butt, Jawad H.
AU - Gislason, Gunnar
AU - Kober, Lars
AU - Fosbol, Emil L.
AU - Sessa, Maurizio
AU - Bhatt, Deepak L.
AU - Torp-Pedersen, Christian
AU - Pareek, Manan
PY - 2022
Y1 - 2022
N2 - Aims To compare the effectiveness and safety of clopidogrel, ticagrelor, and prasugrel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods and results Nationwide, registry-based study of STEMI patients treated with primary PCI (2011-17) and subsequently with aspirin and a P2Y(12) inhibitor. The effectiveness outcome was major adverse cardiovascular events (MACE) defined as a composite of recurrent myocardial infarction, repeat revascularization, stroke, or cardiovascular death at 12 months. The safety outcome was bleeding requiring hospitalization at 12 months. Multivariable logistic regression with average treatment effect modeling was used to calculate absolute and relative risks for outcomes standardized to the distributions of demographic characteristics of all included subjects. We included 10 832 patients; 1 697 were treated with clopidogrel, 7 508 with ticagrelor, and 1,627 with prasugrel. Median ages were 66, 63, and 59 years (P < 0.001). Standardized relative risks of MACE were 0.75 for ticagrelor vs. clopidogrel (95% confidence interval [CI], 0.64-0.83), 0.84 for prasugrel vs. clopidogrel (95% CI, 0.73-0.94), and 1.12 for prasugrel vs. ticagrelor (95% CI, 1.00-1.24). Standardized relative risks of bleeding were 0.77 for ticagrelor vs. clopidogrel (95% CI, 0.59-0.93), 0.89 for prasugrel vs. clopidogrel (95% CI, 0.64-1.15), and 1.17 for prasugrel vs. ticagrelor (95% CI, 0.89-1.45). Conclusion Ticagrelor and prasugrel were associated with lower risks of MACE after STEMI than clopidogrel, and ticagrelor was associated with a marginal reduction compared with prasugrel. The risk of bleeding was lower with ticagrelor compared with clopidogrel, but did not significantly differ between ticagrelor and prasugrel.
AB - Aims To compare the effectiveness and safety of clopidogrel, ticagrelor, and prasugrel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods and results Nationwide, registry-based study of STEMI patients treated with primary PCI (2011-17) and subsequently with aspirin and a P2Y(12) inhibitor. The effectiveness outcome was major adverse cardiovascular events (MACE) defined as a composite of recurrent myocardial infarction, repeat revascularization, stroke, or cardiovascular death at 12 months. The safety outcome was bleeding requiring hospitalization at 12 months. Multivariable logistic regression with average treatment effect modeling was used to calculate absolute and relative risks for outcomes standardized to the distributions of demographic characteristics of all included subjects. We included 10 832 patients; 1 697 were treated with clopidogrel, 7 508 with ticagrelor, and 1,627 with prasugrel. Median ages were 66, 63, and 59 years (P < 0.001). Standardized relative risks of MACE were 0.75 for ticagrelor vs. clopidogrel (95% confidence interval [CI], 0.64-0.83), 0.84 for prasugrel vs. clopidogrel (95% CI, 0.73-0.94), and 1.12 for prasugrel vs. ticagrelor (95% CI, 1.00-1.24). Standardized relative risks of bleeding were 0.77 for ticagrelor vs. clopidogrel (95% CI, 0.59-0.93), 0.89 for prasugrel vs. clopidogrel (95% CI, 0.64-1.15), and 1.17 for prasugrel vs. ticagrelor (95% CI, 0.89-1.45). Conclusion Ticagrelor and prasugrel were associated with lower risks of MACE after STEMI than clopidogrel, and ticagrelor was associated with a marginal reduction compared with prasugrel. The risk of bleeding was lower with ticagrelor compared with clopidogrel, but did not significantly differ between ticagrelor and prasugrel.
KW - ST-segment myocardial infarction
KW - Clopidogrel
KW - Ticagrelor
KW - Prasugrel
KW - DUAL ANTIPLATELET THERAPY
KW - PREHOSPITAL TICAGRELOR
KW - PLATELET INHIBITION
KW - RANDOMIZED-TRIAL
KW - OPEN-LABEL
KW - CLOPIDOGREL
KW - PRASUGREL
KW - REVASCULARIZATION
KW - VALIDATION
KW - OUTCOMES
U2 - 10.1093/ehjacc/zuac095
DO - 10.1093/ehjacc/zuac095
M3 - Journal article
C2 - 35950769
VL - 11
SP - 697
EP - 705
JO - European Heart Journal: Acute Cardiovascular Care
JF - European Heart Journal: Acute Cardiovascular Care
SN - 2048-8726
IS - 9
ER -
ID: 318521176