Key result
Ticagrelor linked to ~15% lower risk of death, MI, or stroke vs clopidogrel post-ACS.
Why the study?
Ticagrelor reduces ischaemic events and mortality in ACS versus clopidogrel, but clinical outcomes in a large real-world population post-ACS needed study.
Does ticagrelor reduce the composite of all-cause death, re-admission with MI or stroke in ACS patients compared to clopidogrel?
Cohort (n=45,073)
Yes
Does ticagrelor reduce the composite of all-cause death, re-admission with MI or stroke in ACS patients compared to clopidogrel?
In a large real-world ACS cohort, ticagrelor was associated with a lower risk of ischemic events and death but a higher risk of bleeding compared to clopidogrel, consistent with randomized trial data.
Answers are grounded in this paper and cite their sources.
Ticagrelor was associated with lower ischemic risk but higher bleeding in real-world ACS; supports randomized data yet leaves net benefit open for prospective confirmation.
AIMS: Ticagrelor reduces ischaemic events and mortality in acute coronary syndrome (ACS) vs. clopidogrel. We wished to study clinical outcomes in a large real-world population post-ACS. METHODS AND RESULTS: We performed a prospective cohort study in 45 073 ACS patients enrolled into Swedish Web system for Enhancement and Development of Evidence-based care in Heart Disease Evaluated According to Recommended Therapies who were discharged on ticagrelor (N = 11 954) or clopidogrel (N = 33 119) between 1 January 2010 and 31 December 2013. The primary outcome was a composite of all-cause death, re-admission with myocardial infarction (MI) or stroke, secondary outcomes as the individual components of the primary outcome, and re-admission with bleeding. The risk of the primary outcome with ticagrelor vs. clopidogrel was 11.7 vs. 22.3% (adjusted hazard ratio (HR) 0.85 [95% confidence interval: 0.78-0.93]), risk of death 5.8 vs. 12.9% (adjusted HR 0.83 [0.75-0.92]), and risk of MI 6.1 vs. 10.8% (adjusted HR 0.89 [0.78-1.01]) at 24 months. Re-admission with bleeding with ticagrelor vs. clopidogrel occurred in 5.5 vs. 5.2% (adjusted HR 1.20 [1.04-1.40]). In a subset of patients undergoing percutaneous coronary intervention (PCI) on ticagrelor vs. clopidogrel the PCI-related in-hospital bleeding was 3.7 vs. 2.7% (adjusted odds ratio, OR, 1.57 [1.30-1.90]). CONCLUSION: Ticagrelor vs. clopidogrel post-ACS was associated with a lower risk of death, MI, or stroke, as well as death alone. Risk of bleeding was higher with ticagrelor. These real-world outcomes are consistent with randomized trial results.
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Sahlén et al. (2016) conducted a cohort in Acute coronary syndrome (ACS) (n=45,073). Ticagrelor vs. Clopidogrel was evaluated on Composite of all-cause death, re-admission with myocardial infarction (MI) or stroke (HR 0.85, 95% CI 0.78-0.93). Ticagrelor was associated with a lower risk of death, MI, or stroke compared to clopidogrel post-ACS (11.7% vs 22.3%; adjusted HR 0.85; 95% CI 0.78-0.93) at 24 months.
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