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Clopidogrel, prasugrel, and ticagrelor for all-comers with ST-segment elevation myocardial infarction

Jacobsen, Mia Ravn ; Engstrøm, Thomas LU ; Torp-Pedersen, Christian ; Gislason, Gunnar H ; Glinge, Charlotte ; Butt, Jawad Haider ; Fosbøl, Emil Loldrup ; Holmvang, Lene ; Pedersen, Frants and Køber, Lars , et al. (2021) In International Journal of Cardiology 342. p.15-22
Abstract

Background: To compare effectiveness and safety of clopidogrel, prasugrel, and ticagrelor among all-comers with ST-segment elevation myocardial infarction (STEMI) and extend the knowledge from randomized clinical trials. Methods: All consecutive patients with STEMI admitted to Copenhagen University Hospital, Rigshospitalet, from 2009 to 2016 were identified via the Eastern Danish Heart Registry. By individual linkage to Danish nationwide registries, claimed drugs and end points were obtained. Patients alive a week post-discharge were included, stratified according to clopidogrel, prasugrel, or ticagrelor treatment, and followed for a year. The effectiveness end point (a composite of all-cause mortality, recurrent myocardial infarction,... (More)

Background: To compare effectiveness and safety of clopidogrel, prasugrel, and ticagrelor among all-comers with ST-segment elevation myocardial infarction (STEMI) and extend the knowledge from randomized clinical trials. Methods: All consecutive patients with STEMI admitted to Copenhagen University Hospital, Rigshospitalet, from 2009 to 2016 were identified via the Eastern Danish Heart Registry. By individual linkage to Danish nationwide registries, claimed drugs and end points were obtained. Patients alive a week post-discharge were included, stratified according to clopidogrel, prasugrel, or ticagrelor treatment, and followed for a year. The effectiveness end point (a composite of all-cause mortality, recurrent myocardial infarction, and ischemic stroke) and safety end point (a composite of bleedings leading to hospitalization) were assessed by multivariate Cox proportional-hazards models. Results: In total, 5123 patients were included (clopidogrel [1245], prasugrel [1902], ticagrelor [1976]) with ≥95% treatment persistency. Concomitant use of aspirin was ≥95%. Females accounted for 24% and elderly for 17%. Compared with clopidogrel, the effectiveness end point occurred less often for ticagrelor (HR 0.50, 95% CI 0.35–0.70) and prasugrel (HR 0.48, 95% CI 0.33–0.68) without differences in bleedings leading to hospitalization. No differences in comparative effectiveness or safety were found between prasugrel and ticagrelor. Sensitivity analyses with time-dependent drug exposure and the period 2011–2015 showed similar results. Conclusions: Among all-comers with STEMI, ticagrelor and prasugrel were associated with reduced incidence of the composite end point of all-cause mortality, recurrent myocardial infarction, and ischemic stroke without an increase in bleedings leading to hospitalization compared with clopidogrel. No differences were found between prasugrel and ticagrelor.

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Contribution to journal
publication status
published
subject
keywords
Clopidogrel, Prasugrel, ST-segment elevation myocardial infarction, Ticagrelor
in
International Journal of Cardiology
volume
342
pages
15 - 22
publisher
Elsevier
external identifiers
  • pmid:34311012
  • scopus:85111945999
ISSN
0167-5273
DOI
10.1016/j.ijcard.2021.07.047
language
English
LU publication?
yes
id
93ab02fb-8004-476c-9796-ed40106ab7e6
date added to LUP
2021-09-02 16:53:15
date last changed
2024-12-01 09:49:20
@article{93ab02fb-8004-476c-9796-ed40106ab7e6,
  abstract     = {{<p>Background: To compare effectiveness and safety of clopidogrel, prasugrel, and ticagrelor among all-comers with ST-segment elevation myocardial infarction (STEMI) and extend the knowledge from randomized clinical trials. Methods: All consecutive patients with STEMI admitted to Copenhagen University Hospital, Rigshospitalet, from 2009 to 2016 were identified via the Eastern Danish Heart Registry. By individual linkage to Danish nationwide registries, claimed drugs and end points were obtained. Patients alive a week post-discharge were included, stratified according to clopidogrel, prasugrel, or ticagrelor treatment, and followed for a year. The effectiveness end point (a composite of all-cause mortality, recurrent myocardial infarction, and ischemic stroke) and safety end point (a composite of bleedings leading to hospitalization) were assessed by multivariate Cox proportional-hazards models. Results: In total, 5123 patients were included (clopidogrel [1245], prasugrel [1902], ticagrelor [1976]) with ≥95% treatment persistency. Concomitant use of aspirin was ≥95%. Females accounted for 24% and elderly for 17%. Compared with clopidogrel, the effectiveness end point occurred less often for ticagrelor (HR 0.50, 95% CI 0.35–0.70) and prasugrel (HR 0.48, 95% CI 0.33–0.68) without differences in bleedings leading to hospitalization. No differences in comparative effectiveness or safety were found between prasugrel and ticagrelor. Sensitivity analyses with time-dependent drug exposure and the period 2011–2015 showed similar results. Conclusions: Among all-comers with STEMI, ticagrelor and prasugrel were associated with reduced incidence of the composite end point of all-cause mortality, recurrent myocardial infarction, and ischemic stroke without an increase in bleedings leading to hospitalization compared with clopidogrel. No differences were found between prasugrel and ticagrelor.</p>}},
  author       = {{Jacobsen, Mia Ravn and Engstrøm, Thomas and Torp-Pedersen, Christian and Gislason, Gunnar H and Glinge, Charlotte and Butt, Jawad Haider and Fosbøl, Emil Loldrup and Holmvang, Lene and Pedersen, Frants and Køber, Lars and Jabbari, Reza and Sørensen, Rikke}},
  issn         = {{0167-5273}},
  keywords     = {{Clopidogrel; Prasugrel; ST-segment elevation myocardial infarction; Ticagrelor}},
  language     = {{eng}},
  pages        = {{15--22}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Cardiology}},
  title        = {{Clopidogrel, prasugrel, and ticagrelor for all-comers with ST-segment elevation myocardial infarction}},
  url          = {{http://dx.doi.org/10.1016/j.ijcard.2021.07.047}},
  doi          = {{10.1016/j.ijcard.2021.07.047}},
  volume       = {{342}},
  year         = {{2021}},
}