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

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:342

Article

Jacobsen, Mia Ravn^1,2  Engstrom, Thomas^1,3  Torp-Pedersen, Christian^2,4  Gislason, Gunnar⁵  Glinge, Charlotte¹  Butt, Jawad Haider¹  Fosbol, Emil Loldrup¹  Holmvang, Lene¹  Pedersen, Frants¹  Kober, Lars¹  Jabbari, Reza¹  Sorensen, Rikke¹ 

[1] Copenhagen Univ Hosp, Rigshosp, Dept Cardiol, Inge Lehmans Vej 7, DK-2100 Copenhagen O, Denmark

[2] Aalborg Univ Hosp, Dept Cardiol, Aalborg, Denmark

[3] Lund Univ, Dept Cardiol, Lund, Sweden

[4] Nordsjaelland Hosp, Dept Clin Res & Cardiol, Hillerod, Denmark

[5] Herlev & Gentofte Univ Hosp, Dept Cardiol, Hellerup, Denmark

关键词: ST-segment elevation myocardial infarction;    Clopidogrel;    Prasugrel;    Ticagrelor;   

DOI  :  10.1016/j.ijcard.2021.07.047

来源: Elsevier

【 摘 要 】

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 proportionalhazards 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.

【 授权许可】

Free