Real-world comparison of clopidogrel, prasugrel and ticagrelor in patients undergoing primary percutaneous coronary intervention
Background There is a paucity of real-world outcome data comparing clopidogrel, prasugrel and ticagrelor in primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). We sought to assess the association of choice of oral P2Y12-receptor inhibitor with cl...
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| Format: | Article |
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BMJ Publishing Group
2019-05-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/6/1/e000951.full |
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| author | Jim McLenachan Christopher Malkin Daniel J Blackman John Greenwood Stephen Wheatcroft Paul Baxter Arvindra Krishnamurthy Claire Keeble Michelle Anderson Kathryn Somers Natalie Burton-Wood Charlotte Harland Jonathan Blaxill |
| author_facet | Jim McLenachan Christopher Malkin Daniel J Blackman John Greenwood Stephen Wheatcroft Paul Baxter Arvindra Krishnamurthy Claire Keeble Michelle Anderson Kathryn Somers Natalie Burton-Wood Charlotte Harland Jonathan Blaxill |
| author_sort | Jim McLenachan |
| collection | DOAJ |
| description | Background There is a paucity of real-world outcome data comparing clopidogrel, prasugrel and ticagrelor in primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). We sought to assess the association of choice of oral P2Y12-receptor inhibitor with clinical outcomes following PPCI for STEMI in a large consecutive patient series.Methods Demographic, procedural and 12-month outcome data were prospectively collected for all patients undergoing PPCI in Leeds, UK, between 01 January 2009 and 31 December 2011, and 01 January 2013 and 31 December 2013. Clinical endpoints were 30-day and 12-month all-cause mortality, recurrent MI and 30-day HORIZONS-major bleeding. Logistic regression analyses were undertaken to adjust for confounding factors.Results Prasugrel (n=1244) was associated with lower adjusted 30-day (OR 0.53 (0.34–0.85)) and 12-month (OR 0.55 (0.38–0.78)) mortality, and 12-month MI (OR 0.63 (0.42–0.94)) compared with clopidogrel (n=1648). Importantly, prasugrel was associated with lower adjusted 30-day mortality (OR 0.51 (0.29–0.91)) compared with ticagrelor (n=811). Lower 30-day (OR 0.40 (0.17–0.94)) and 12-month (OR 0.54 (0.32–0.93)) MI were observed in ticagrelor compared with clopidogrel, an association absent in comparison with prasugrel. Adjusted bleeding were not statistically significantly different among the P2Y12-receptor inhibitors.Conclusion In this large consecutive real-world series, prasugrel was associated with lower adjusted 30-day mortality compared with ticagrelor and clopidogrel, and lower adjusted 12-month mortality compared with clopidogrel. Both prasugrel and ticagrelor were associated with lower recurrent MI following PPCI compared with clopidogrel, with no overall increase in adjusted bleeding. |
| format | Article |
| id | doaj-art-f95db73e7a224b45a614656710b04c94 |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2019-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-f95db73e7a224b45a614656710b04c942024-11-12T05:30:08ZengBMJ Publishing GroupOpen Heart2053-36242019-05-016110.1136/openhrt-2018-000951Real-world comparison of clopidogrel, prasugrel and ticagrelor in patients undergoing primary percutaneous coronary interventionJim McLenachan0Christopher Malkin1Daniel J Blackman2John Greenwood3Stephen Wheatcroft4Paul Baxter5Arvindra Krishnamurthy6Claire Keeble7Michelle Anderson8Kathryn Somers9Natalie Burton-Wood10Charlotte Harland11Jonathan Blaxill122 Department of Cardiology, Leeds General Infirmary, Leeds, UK2 Department of Cardiology, Leeds General Infirmary, Leeds, UK7 Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK1University of Leeds, University of Leeds, Leeds, WYK LS29JT, UK2 Department of Cardiology, Leeds General Infirmary, Leeds, UK1 Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK2 Department of Cardiology, Leeds General Infirmary, Leeds, UK1 Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKDepartment of Cardiology, Leeds General Infirmary, Leeds, UKDepartment of Cardiology, Leeds General Infirmary, Leeds, UKDepartment of Cardiology, Leeds General Infirmary, Leeds, UKDepartment of Cardiology, Leeds General Infirmary, Leeds, UK2 Department of Cardiology, Leeds General Infirmary, Leeds, UKBackground There is a paucity of real-world outcome data comparing clopidogrel, prasugrel and ticagrelor in primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). We sought to assess the association of choice of oral P2Y12-receptor inhibitor with clinical outcomes following PPCI for STEMI in a large consecutive patient series.Methods Demographic, procedural and 12-month outcome data were prospectively collected for all patients undergoing PPCI in Leeds, UK, between 01 January 2009 and 31 December 2011, and 01 January 2013 and 31 December 2013. Clinical endpoints were 30-day and 12-month all-cause mortality, recurrent MI and 30-day HORIZONS-major bleeding. Logistic regression analyses were undertaken to adjust for confounding factors.Results Prasugrel (n=1244) was associated with lower adjusted 30-day (OR 0.53 (0.34–0.85)) and 12-month (OR 0.55 (0.38–0.78)) mortality, and 12-month MI (OR 0.63 (0.42–0.94)) compared with clopidogrel (n=1648). Importantly, prasugrel was associated with lower adjusted 30-day mortality (OR 0.51 (0.29–0.91)) compared with ticagrelor (n=811). Lower 30-day (OR 0.40 (0.17–0.94)) and 12-month (OR 0.54 (0.32–0.93)) MI were observed in ticagrelor compared with clopidogrel, an association absent in comparison with prasugrel. Adjusted bleeding were not statistically significantly different among the P2Y12-receptor inhibitors.Conclusion In this large consecutive real-world series, prasugrel was associated with lower adjusted 30-day mortality compared with ticagrelor and clopidogrel, and lower adjusted 12-month mortality compared with clopidogrel. Both prasugrel and ticagrelor were associated with lower recurrent MI following PPCI compared with clopidogrel, with no overall increase in adjusted bleeding.https://openheart.bmj.com/content/6/1/e000951.full |
| spellingShingle | Jim McLenachan Christopher Malkin Daniel J Blackman John Greenwood Stephen Wheatcroft Paul Baxter Arvindra Krishnamurthy Claire Keeble Michelle Anderson Kathryn Somers Natalie Burton-Wood Charlotte Harland Jonathan Blaxill Real-world comparison of clopidogrel, prasugrel and ticagrelor in patients undergoing primary percutaneous coronary intervention Open Heart |
| title | Real-world comparison of clopidogrel, prasugrel and ticagrelor in patients undergoing primary percutaneous coronary intervention |
| title_full | Real-world comparison of clopidogrel, prasugrel and ticagrelor in patients undergoing primary percutaneous coronary intervention |
| title_fullStr | Real-world comparison of clopidogrel, prasugrel and ticagrelor in patients undergoing primary percutaneous coronary intervention |
| title_full_unstemmed | Real-world comparison of clopidogrel, prasugrel and ticagrelor in patients undergoing primary percutaneous coronary intervention |
| title_short | Real-world comparison of clopidogrel, prasugrel and ticagrelor in patients undergoing primary percutaneous coronary intervention |
| title_sort | real world comparison of clopidogrel prasugrel and ticagrelor in patients undergoing primary percutaneous coronary intervention |
| url | https://openheart.bmj.com/content/6/1/e000951.full |
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