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.
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.
Sahlén et al. (Tue,) studied this question.