Comparison Between Ticagrelor and Clopidogrel in Elderly Patients With an Acute Coronary Syndrome : Insights From the SWEDEHEART Registry
(2020) In Circulation 142(18). p.1700-1708- Abstract
BACKGROUND: The comparative efficacy and safety of ticagrelor versus clopidogrel in older patients with myocardial infarction (MI) has received limited study. METHODS: We performed an observational analysis of all patients ≥80 years (n=14 005) who were discharged alive with aspirin combined with either clopidogrel (60.2%) or ticagrelor (39.8%) after a MI between 2010 and 2017 registered in the national registry SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). Inverse probability treatment weighting was used in Cox regression models to adjust for differences in demographics, in-hospital therapies, and medications. The primary ischemic... (More)
BACKGROUND: The comparative efficacy and safety of ticagrelor versus clopidogrel in older patients with myocardial infarction (MI) has received limited study. METHODS: We performed an observational analysis of all patients ≥80 years (n=14 005) who were discharged alive with aspirin combined with either clopidogrel (60.2%) or ticagrelor (39.8%) after a MI between 2010 and 2017 registered in the national registry SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). Inverse probability treatment weighting was used in Cox regression models to adjust for differences in demographics, in-hospital therapies, and medications. The primary ischemic outcome (death, MI, or stroke), and bleeding were obtained from national registries at 1 year. A sensitivity analysis in <80-year-old patients was performed. RESULTS: In patients ≥80 years, the incidence of the primary ischemic outcome (hazard ratio [HR], 0.97 [95% CI, 0.88-1.06]) was similar for ticagrelor- and clopidogrel-treated patients. Ticagrelor was associated with a 17% and 48% higher risk of death (HR, 1.17 [95% CI, 1.03-1.32]) and bleeding (HR, 1.48 [95% CI, 1.25-1.76]), but a lower risk of MI (HR, 0.80 [95% CI, 0.70-0.92]) and stroke (HR, 0.72 [95% CI, 0.56-0.93]). In <80-year-old patients, the incidence of the primary ischemic outcome was 17% (HR, 0.83 [95% CI, 0.77-0.89]) lower with ticagrelor. Ticagrelor was associated with 15% (HR, 0.85 [95% CI, 0.76-0.96]) lower risk of death, 32% higher risk of bleeding (HR, 1.32 [95% CI, 1.18-1.47]), but lower risk of MI (HR, 0.82 [95% CI, 0.75-0.91]) and stroke (HR, 0.82 [95% CI, 0.69-0.98]). CONCLUSIONS: Ticagrelor use among elderly patients with MI was associated with higher risk of bleeding and death compared with clopidogrel. A randomized study of ticagrelor versus clopidogrel in the elderly is needed.
(Less)
- author
- Szummer, Karolina ; Montez-Rath, Maria E. ; Alfredsson, Joakim ; Erlinge, David LU ; Lindahl, Bertil ; Hofmann, Robin ; Ravn-Fischer, Annica ; Svensson, Per and Jernberg, Tomas
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- antiplatelet therapy, elderly, myocardial infarction, prognosis, risk-benefit
- in
- Circulation
- volume
- 142
- issue
- 18
- pages
- 9 pages
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- scopus:85095461607
- pmid:32867508
- ISSN
- 1524-4539
- DOI
- 10.1161/CIRCULATIONAHA.120.050645
- language
- English
- LU publication?
- yes
- id
- 985a7171-7657-4e0e-a6a2-21a1c98a5cf2
- date added to LUP
- 2020-11-13 11:42:58
- date last changed
- 2024-09-05 07:58:33
@article{985a7171-7657-4e0e-a6a2-21a1c98a5cf2, abstract = {{<p>BACKGROUND: The comparative efficacy and safety of ticagrelor versus clopidogrel in older patients with myocardial infarction (MI) has received limited study. METHODS: We performed an observational analysis of all patients ≥80 years (n=14 005) who were discharged alive with aspirin combined with either clopidogrel (60.2%) or ticagrelor (39.8%) after a MI between 2010 and 2017 registered in the national registry SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). Inverse probability treatment weighting was used in Cox regression models to adjust for differences in demographics, in-hospital therapies, and medications. The primary ischemic outcome (death, MI, or stroke), and bleeding were obtained from national registries at 1 year. A sensitivity analysis in <80-year-old patients was performed. RESULTS: In patients ≥80 years, the incidence of the primary ischemic outcome (hazard ratio [HR], 0.97 [95% CI, 0.88-1.06]) was similar for ticagrelor- and clopidogrel-treated patients. Ticagrelor was associated with a 17% and 48% higher risk of death (HR, 1.17 [95% CI, 1.03-1.32]) and bleeding (HR, 1.48 [95% CI, 1.25-1.76]), but a lower risk of MI (HR, 0.80 [95% CI, 0.70-0.92]) and stroke (HR, 0.72 [95% CI, 0.56-0.93]). In <80-year-old patients, the incidence of the primary ischemic outcome was 17% (HR, 0.83 [95% CI, 0.77-0.89]) lower with ticagrelor. Ticagrelor was associated with 15% (HR, 0.85 [95% CI, 0.76-0.96]) lower risk of death, 32% higher risk of bleeding (HR, 1.32 [95% CI, 1.18-1.47]), but lower risk of MI (HR, 0.82 [95% CI, 0.75-0.91]) and stroke (HR, 0.82 [95% CI, 0.69-0.98]). CONCLUSIONS: Ticagrelor use among elderly patients with MI was associated with higher risk of bleeding and death compared with clopidogrel. A randomized study of ticagrelor versus clopidogrel in the elderly is needed.</p>}}, author = {{Szummer, Karolina and Montez-Rath, Maria E. and Alfredsson, Joakim and Erlinge, David and Lindahl, Bertil and Hofmann, Robin and Ravn-Fischer, Annica and Svensson, Per and Jernberg, Tomas}}, issn = {{1524-4539}}, keywords = {{antiplatelet therapy; elderly; myocardial infarction; prognosis; risk-benefit}}, language = {{eng}}, number = {{18}}, pages = {{1700--1708}}, publisher = {{Lippincott Williams & Wilkins}}, series = {{Circulation}}, title = {{Comparison Between Ticagrelor and Clopidogrel in Elderly Patients With an Acute Coronary Syndrome : Insights From the SWEDEHEART Registry}}, url = {{http://dx.doi.org/10.1161/CIRCULATIONAHA.120.050645}}, doi = {{10.1161/CIRCULATIONAHA.120.050645}}, volume = {{142}}, year = {{2020}}, }