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Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction : Experiences from SWEDEHEART registry

Sahlén, Anders ; Varenhorst, Christoph ; Lagerqvist, Bo ; Renlund, Henrik ; Omerovic, Elmir ; Erlinge, David LU orcid ; Wallentin, Lars LU ; James, Stefan K. and Jernberg, Tomas (2016) In European Heart Journal 37. p.3335-3342
Abstract

Aims: Ticagrelor reduces ischaemic events and mortality in acute coronary syndrome (ACS) vs. clopidogrel. We wished to study clinical outcomes in a large real-world population post-ACS. Methods and results: We performed a prospective cohort study in 45 073 ACS patients enrolled into SwedishWeb system for Enhancement and Development of Evidence-based care in Heart Disease Evaluated According to Recommended Therapies who were discharged on ticagrelor (N = 11 954) or clopidogrel (N = 33 119) between 1 January 2010 and 31 December 2013. The primary outcome was a composite of all-cause death, re-admission with myocardial infarction (MI) or stroke, secondary outcomes as the individual components of the primary outcome, and re-admission with... (More)

Aims: Ticagrelor reduces ischaemic events and mortality in acute coronary syndrome (ACS) vs. clopidogrel. We wished to study clinical outcomes in a large real-world population post-ACS. Methods and results: We performed a prospective cohort study in 45 073 ACS patients enrolled into SwedishWeb system for Enhancement and Development of Evidence-based care in Heart Disease Evaluated According to Recommended Therapies who were discharged on ticagrelor (N = 11 954) or clopidogrel (N = 33 119) between 1 January 2010 and 31 December 2013. The primary outcome was a composite of all-cause death, re-admission with myocardial infarction (MI) or stroke, secondary outcomes as the individual components of the primary outcome, and re-admission with bleeding. The risk of the primary outcome with ticagrelor vs. clopidogrel was 11.7 vs. 22.3% (adjusted hazard ratio (HR) 0.85 [95% confidence interval: 0.78-0.93]), risk of death 5.8 vs. 12.9% (adjusted HR 0.83 [0.75-0.92]), and risk of MI 6.1 vs. 10.8% (adjusted HR 0.89 [0.78-1.01]) at 24 months. Re-admission with bleeding with ticagrelor vs. clopidogrel occurred in 5.5 vs. 5.2% (adjusted HR 1.20 [1.04-1.40]). In a subset of patients undergoing percutaneous coronary intervention (PCI) on ticagrelor vs. clopidogrel the PCI-related in-hospital bleeding was 3.7 vs. 2.7% (adjusted odds ratio, OR, 1.57 [1.30-1.90]). Conclusion: Ticagrelor vs. clopidogrel post-ACS was associated with a lower risk of death, MI, or stroke, as well as death alone. Risk of bleeding was higher with ticagrelor. These real-world outcomes are consistent with randomized trial results.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute coronary syndrome, Platelet inhibition, Ticagrelor
in
European Heart Journal
volume
37
pages
8 pages
publisher
Oxford University Press
external identifiers
  • pmid:27436867
  • wos:000393983900013
  • scopus:85015801112
ISSN
0195-668X
DOI
10.1093/eurheartj/ehw284
language
English
LU publication?
yes
id
d8224704-ee4d-4f19-bed7-9e2f73a16065
date added to LUP
2017-04-20 09:57:52
date last changed
2025-01-20 13:18:14
@article{d8224704-ee4d-4f19-bed7-9e2f73a16065,
  abstract     = {{<p>Aims: Ticagrelor reduces ischaemic events and mortality in acute coronary syndrome (ACS) vs. clopidogrel. We wished to study clinical outcomes in a large real-world population post-ACS. Methods and results: We performed a prospective cohort study in 45 073 ACS patients enrolled into SwedishWeb system for Enhancement and Development of Evidence-based care in Heart Disease Evaluated According to Recommended Therapies who were discharged on ticagrelor (N = 11 954) or clopidogrel (N = 33 119) between 1 January 2010 and 31 December 2013. The primary outcome was a composite of all-cause death, re-admission with myocardial infarction (MI) or stroke, secondary outcomes as the individual components of the primary outcome, and re-admission with bleeding. The risk of the primary outcome with ticagrelor vs. clopidogrel was 11.7 vs. 22.3% (adjusted hazard ratio (HR) 0.85 [95% confidence interval: 0.78-0.93]), risk of death 5.8 vs. 12.9% (adjusted HR 0.83 [0.75-0.92]), and risk of MI 6.1 vs. 10.8% (adjusted HR 0.89 [0.78-1.01]) at 24 months. Re-admission with bleeding with ticagrelor vs. clopidogrel occurred in 5.5 vs. 5.2% (adjusted HR 1.20 [1.04-1.40]). In a subset of patients undergoing percutaneous coronary intervention (PCI) on ticagrelor vs. clopidogrel the PCI-related in-hospital bleeding was 3.7 vs. 2.7% (adjusted odds ratio, OR, 1.57 [1.30-1.90]). Conclusion: Ticagrelor vs. clopidogrel post-ACS was associated with a lower risk of death, MI, or stroke, as well as death alone. Risk of bleeding was higher with ticagrelor. These real-world outcomes are consistent with randomized trial results.</p>}},
  author       = {{Sahlén, Anders and Varenhorst, Christoph and Lagerqvist, Bo and Renlund, Henrik and Omerovic, Elmir and Erlinge, David and Wallentin, Lars and James, Stefan K. and Jernberg, Tomas}},
  issn         = {{0195-668X}},
  keywords     = {{Acute coronary syndrome; Platelet inhibition; Ticagrelor}},
  language     = {{eng}},
  pages        = {{3335--3342}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal}},
  title        = {{Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction : Experiences from SWEDEHEART registry}},
  url          = {{http://dx.doi.org/10.1093/eurheartj/ehw284}},
  doi          = {{10.1093/eurheartj/ehw284}},
  volume       = {{37}},
  year         = {{2016}},
}