Comparison of Clinical Outcomes in Acute Coronary Syndrome Patients Who Undergo Percutaneous Coronary Intervention Using Different P2Y12 Inhibitors: A SMS Hospital Based Observational Study

Background To compare the safety, and efficacy of contemporary P2Y12 inhibitors, prescription rates, drug defaulter and switch over rates in acute coronary syndrome (ACS) patients following percutaneous coronary intervention (PCI). Methods in this prospective observational study we studied 195 ACS patients who underwent PCI in SMS Hospital, Jaipur. We compared prescription rates, bleeding, and major adverse cardiac events (MACEs: cardiac death, nonfatal myocardial infarction, or stroke) according to ticagrelor, prasugrel, or clopidogrel use. Results The prescription rates of ticagrelor, prasugrel, and clopidogrel were 29.5%, 4.3%, and 66.2% respectively. Bleeding occurred in total 6 patients (2.9%) out of which 3 patients (2.2%) in clopidogrel group, 1 patient (11.1%) in prasugrel group and 2 patients (3.2%) in ticagrelor group (p=0.29)), respectively, with higher incidence in ticagrelor and prasugrel users than in clopidogrel users but statistically not significant. After six month follow up, all-cause mortality was total 5 cases (2.4%) out of which 4 death (2.9%) occurred in clopidogrel group while 1 death (1.6%) occurred in ticagrelor group(p=0.76). no mortality was recorded in prasugrel group. Repeat myocardial infarction (Re MI) occurred in total 4 patients (1.9%) with 2 patients in clopidogrel and ticagrelor group each. A total 5 patients (2.4%) switch over to another p2y12 inhibitor, mostly from ticagrelor group(p=0.045). During this follow up period, a total of 4 patients (1.9%) were drug defaulter (0.622). Conclusions As clopidogrel based DAPT was prescribed more in our centre because of free institutional supply and found no significant difference in clinical outcomes, although slight increase in bleeding risk in ticagrelor or prasugrel based DAPT, demonstrate clopidogrel based DAPT regime can be preferably prescribed safely in our population. Drug defaulter rates in first six month following PCI are low in all groups but more switch over from ticagrelor group to other groups significantly shows importance of low cost and free institutional supply in drug adherence.