Key result
Prasugrel (OR 0.45; 95% CI 0.31-0.67) and ticagrelor (OR 0.84; 95% CI 0.71-0.98) were associated with significantly lower 30-day mortality in AMI patients compared to clopidogrel.
Why the study?
Do new antiplatelet agents (prasugrel and ticagrelor) reduce 30-day mortality compared to clopidogrel in AMI patients undergoing percutaneous coronary intervention?
Observational
Do new antiplatelet agents (prasugrel and ticagrelor) reduce 30-day mortality compared to clopidogrel in AMI patients undergoing percutaneous coronary intervention?
In a Korean nationwide real-world cohort, the use of newer P2Y12 inhibitors (prasugrel and ticagrelor) in AMI patients undergoing PCI was associated with significantly reduced 30-day mortality compared to clopidogrel, without an increase in 30-day bleeding.
Answers are grounded in this paper and cite their sources.
New P2Y12 inhibitors were associated with lower 30-day mortality in Korean AMI; leaves open net benefit on nonfatal outcomes or practice change.
BACKGROUND AND OBJECTIVES: Despite the favorable efficacy of new antiplatelet agents demonstrated in randomized controlled trials, their clinical implications in Korea are unclear. The purpose of this study was to investigate trends in antiplatelet agent use for acute myocardial infarction (AMI) and their impact on 30-day clinical outcomes. METHODS: AMI patients undergoing percutaneous coronary intervention between 2010 and 2015 were assessed using claim data from the Health Insurance Review and Assessment Service. RESULTS: The use of new antiplatelet agents has rapidly increased since 2013 and has been preferred over clopidogrel (Plavix; Bristol-Myers Squibb/Sanofi Pharmaceuticals) since 2015. Both prasugrel (Effient; Eli Lilly and Company) (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.31-0.67; p<0.001) and ticagrelor (Brilinta; AstraZeneca Pharmaceuticals LP) (OR, 0.84; 95% CI, 0.71-0.98; p=0.032) had an independent effect on lowering 30-day mortality in a weighted multivariable logistic regression model. However, new antiplatelet agents had no significant effect on other clinical outcomes including myocardial infarction, stroke, bleeding, and readmission within 30 days. CONCLUSION: The use of new antiplatelet agents is rapidly increasing, and they have been used more commonly than clopidogrel since 2015. We demonstrated that new antiplatelet agents have a favorable effect on reducing 30-day mortality in AMI patients in Korea.
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Kim et al. (2017) conducted an observational in acute myocardial infarction (AMI). New antiplatelet agents (prasugrel and ticagrelor) vs. clopidogrel was evaluated on 30-day mortality (OR 0.45, 95% CI 0.31-0.67, p=<0.001). Prasugrel (OR 0.45; 95% CI 0.31-0.67) and ticagrelor (OR 0.84; 95% CI 0.71-0.98) were associated with significantly lower 30-day mortality in AMI patients compared to clopidogrel.
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