Why the study?
Long-term prognosis and clinical characteristics related to antiplatelet prescription type in current clinical practice ACS patients had not been analysed in depth.
Do novel oral P2Y12 inhibitors (prasugrel and ticagrelor) reduce adverse cardiovascular events and mortality compared to clopidogrel in patients discharged after acute coronary syndrome in real-world practice?
Observational (n=1,717)
Yes
Do novel oral P2Y12 inhibitors (prasugrel and ticagrelor) reduce adverse cardiovascular events and mortality compared to clopidogrel in patients discharged after acute coronary syndrome in real-world practice?
Hazard Ratio: 0.49 (95% CI 0.24–0.98)
p-value: p=0.044
In a real-world registry of ACS patients, the use of novel oral P2Y12 inhibitors at discharge was associated with significantly lower all-cause mortality and MACE compared to clopidogrel, without an increase in major bleeding.
Background Prasugrel and ticagrelor have demonstrated higher efficacy than clopidogrel in their main clinical trials for patients with acute coronary syndrome (ACS). However, the long‐term prognosis and different clinical characteristics related to the type of antiplatelet prescription in current clinical practice ACS patients have not been analysed in depth. The objective of this study was to analyse the clinical profile of ACS and the efficacy and safety of novel oral P2Y 12 inhibitors in current clinical practice patients discharged afterACS. Methods We collected data from the ACHILLES registry, and an observational, prospective and multicentre registry of patients discharged after ACS. We analysed baseline characteristics, clinical profile and therapy during ACS admission and compared with the different treatments at discharge. After 1 year of follow‐up, ischaemic and major bleeding events were analysed. Multivariate Cox regression analysis and Kaplan Meier curves were also plotted. Results Of 1717 consecutive patients, 1294 (75.4%) were discharged with a P2Y12 inhibitor without oral anticoagulation. Novel oral P2Y 12 inhibitors were indicated in 47%. Patients treated with clopidogrel were elderly (69.1 ± 13.4 vs 60.4 ± 11.5 years; P < .001) and had a higher prevalence of cardiovascular risk factors. GRACE and CRUSADE scores were higher in the clopidogrel than in novel oral P2Y 12 inhibitors group ( P < .001). After 1 year of follow‐up, 64(5.0%/year) patients had a new myocardial infarction, 127(10.0%/year) had a major adverse cardiovascular event (MACE) and 78(6.1%/year) died. Patients treated with clopidogrel had a significantly higher annual rate of cardiovascular mortality, MACE and all‐cause mortality (all P < .001) without differences in major bleeding ( P = .587) compared with novel oral P2Y 12 inhibitors. After multivariate adjustment for the main clinical variables related to adverse prognosis in ACS patients, the discharge with novel oral P2Y 12 inhibitors therapy was independently associated with lower risk of all‐cause mortality (HR0.49, 95% CI [0.24‐0.98], P = .044) and lower risk of MACE (HR0.64, 95% CI [0.41‐0.98], P = .044). Conclusions In this prospective, observational and current clinical practice ACS registry, the use of novel oral P2Y 12 inhibitors was associated with a reduction in adverse events compared with clopidogrel in patients with ACS. Novel oral P2Y 12 inhibitors prescription at discharge was independently associated with lower all‐cause mortality and MACE without differences in bleeding events. However, clopidogrel remained the most common P2Y12 inhibitor employed for ACS, especially in older and high‐risk patients.
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Ruiz-Nodar et al. (2020) conducted an observational in Acute coronary syndrome (ACS) (n=1,717). Novel oral P2Y12 inhibitors (prasugrel and ticagrelor) vs. Clopidogrel was evaluated on All-cause mortality (HR 0.49, 95% CI 0.24-0.98, p=0.044).
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