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

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

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.

antiplatelet drugs, clopidogrel, prasugrel, primary PCI, ticagrelor
1355-6037
1683-1690
Olier, Ivan
c2f14930-6e95-4889-bb02-70e5a5b570d7
Sirker, Alex
906f90ca-feaf-437c-8bf2-fbdaa36e80cb
Hildick-Smith, David J.R.
336389cd-35ff-4c3d-a301-0be19cfa59ac
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Ludman, Peter
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
De Belder, Mark A.
3d0eff51-f1d1-41a7-aac1-e193db082360
Baumbach, Andreas
c5cc2c9b-73d8-402e-8aaa-8b856da9f7f3
Byrne, Jonathan
fb222541-f0b5-4ba1-a778-c9623884b715
Rashid, Muhammad
5c319e5f-cc0f-4039-bfc3-54e2c948004d
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Mamas, Mamas A.
5e691a39-5922-435c-9ce0-53a74a66a23f
Olier, Ivan
c2f14930-6e95-4889-bb02-70e5a5b570d7
Sirker, Alex
906f90ca-feaf-437c-8bf2-fbdaa36e80cb
Hildick-Smith, David J.R.
336389cd-35ff-4c3d-a301-0be19cfa59ac
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Ludman, Peter
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
De Belder, Mark A.
3d0eff51-f1d1-41a7-aac1-e193db082360
Baumbach, Andreas
c5cc2c9b-73d8-402e-8aaa-8b856da9f7f3
Byrne, Jonathan
fb222541-f0b5-4ba1-a778-c9623884b715
Rashid, Muhammad
5c319e5f-cc0f-4039-bfc3-54e2c948004d
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Mamas, Mamas A.
5e691a39-5922-435c-9ce0-53a74a66a23f

Olier, Ivan, Sirker, Alex, Hildick-Smith, David J.R., Kinnaird, Tim, Ludman, Peter, De Belder, Mark A., Baumbach, Andreas, Byrne, Jonathan, Rashid, Muhammad, Curzen, Nick and Mamas, Mamas A. (2018) Association of different antiplatelet therapies with mortality after primary percutaneous coronary intervention. Heart, 104 (20), 1683-1690. (doi:10.1136/heartjnl-2017-312366).

Record type: Article

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.

Full text not available from this repository.

More information

Accepted/In Press date: 7 January 2018
e-pub ahead of print date: 2 February 2018
Published date: October 2018
Keywords: antiplatelet drugs, clopidogrel, prasugrel, primary PCI, ticagrelor

Identifiers

Local EPrints ID: 422217
URI: http://eprints.soton.ac.uk/id/eprint/422217
ISSN: 1355-6037
PURE UUID: f72fc898-34f9-433e-ae3a-f6d7f17ca738
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

Catalogue record

Date deposited: 19 Jul 2018 16:30
Last modified: 30 Mar 2021 01:41

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