Why the study?
Although randomized trials show novel antithrombotic therapies improve in-hospital outcomes in STEMI, their effectiveness and safety in clinical practice required description using contemporary registry data.
Do new P2Y12 receptor inhibitors (prasugrel or ticagrelor) reduce all-cause in-hospital death compared to clopidogrel in patients with STEMI?
Do new P2Y12 receptor inhibitors (prasugrel or ticagrelor) reduce all-cause in-hospital death compared to clopidogrel in patients with STEMI?
In real-world European registries, the use of newer P2Y12 inhibitors (prasugrel or ticagrelor) in STEMI patients is associated with significantly lower in-hospital mortality compared to clopidogrel, without a significant increase in major bleeding.
Newer P2Y12 inhibitors were associated with lower STEMI mortality; leaves open confirmation versus clopidogrel in randomized trials.
AIMS: Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. Recent randomized clinical trials have demonstrated that novel antithrombotic therapies improve in-hospital outcomes in STEMI patients. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in clinical practice in patients with STEMI based on data from contemporary European ACS registries. METHODS AND RESULTS: Five registries from the PIRAEUS initiative (AAPCI/ADPAT, ALKK-PIC, AMIS Plus, Belgium STEMI, and EYESHOT) provided data for the assessment of P2Y12 receptor inhibitor-based dual antiplatelet therapy. Registries were heterogeneous in terms of setting, patient characteristics, and treatment selection. Matched pair analysis and propensity score matching were used to assess all-cause in-hospital death rates based on data from 25 250 patients (8577 patients on prasugrel, 5995 on ticagrelor, and 10 678 on clopidogrel). The odds ratio (OR) for the death of any cause when compared with clopidogrel was 0.72 [95% confidence interval (CI) 0.62-0.84, P < 0.001] in favour of the new P2Y12 receptor inhibitors (prasugrel and ticagrelor combined). In the comparison between prasugrel and ticagrelor, there were no relevant differences (OR 0.97, 95% CI 0.77-1.23; P = 0.81). Event rates of cardiovascular death and stroke were also substantially lower for the new P2Y12 receptor inhibitors. The differences between clopidogrel and prasugrel or ticagrelor on major bleeding were numerically in the same order as for death of any cause but were not statistically significant. No differences in ischaemic and bleeding outcomes were observed between prasugrel and ticagrelor. CONCLUSION: This analysis suggests that the prasugrel or ticagrelor compared with clopidogrel have favourable outcomes in clinical practice while not being inferior in terms of safety.
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Luca et al. (2020) studied this question.
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