Aims:
We investigated the impact of new platelet P2Y12 inhibitors, prasugrel and ticagrelor, compared with clopidogrel, upon mortality and stent thrombosis (ST) in patients with acute coronary syndromes (ACS) in a large, single-centre, ‘all-comers’ population.
Methods:
Data were collected for 6742 consecutive patients attending the cardiac catheterization lab at Sheffield, UK (2009-2013) with ACS. Differences in outcomes among patients receiving different P2Y12 inhibitors were evaluated at 12 months by Kaplan-Meier curves and log-rank test in the overall and a propensity-matched population.
Results:
Of 6742 patients with ACS (36% STEMI, 64% NSTE-ACS), 67% (4525) received clopidogrel, 15% (1007) prasugrel and 18% (1210) ticagrelor, with aspirin for all. In the overall group, prasugrel (HR 0.78, 95% CI 0.59-1.02, p=0.07) and ticagrelor (HR 0.77, 95% CI 0.60-0.99, p=0.04) were associated with lower all-cause mortality compared with clopidogrel (Fig 1A). There was no difference in mortality between prasugrel- and ticagrelor-treated groups (HR 1.01, 95% CI 1.00-1.67, p=0.96). The incidence of definite/probable ST was 4.2% (1.5% definite, 2.7% probable) at 12 months. ST rates were nearly 2-fold higher in patients treated with either clopidogrel or prasugrel compared with ticagrelor (Fig 1B). In the STEMI subgroup, lower mortality and ST rates were observed with new P2Y12 inhibitors but no significant differences between prasugrel and ticagrelor (Fig 1C and 1D). The results for all ACS population or STEMI subgroup remained similar after adjustment for confounding variables or analysing propensity-matched cohorts.
Conclusions:
Both prasugrel and ticagrelor appear superior to clopidogrel for reduction in mortality in ACS in the ‘real world’. Ticagrelor was associated with the lowest mortality and ST rates in all ACS patients, whereas either prasugrel or ticagrelor appear suitable in STEMI patients without contraindications.
Comparison of P2Y12 inhibitors for mortality and stent thrombosis in patients with acute coronary syndromes: Single center study of 10 793 consecutive ‘real-world’ patients