Real-world data confirm benefits of ticagrelor in ACS
medwireNews: A prospective study of more than 45,000 patients with acute coronary syndromes (ACS) has shown that the risk of death or readmission with myocardial infarction (MI) or stroke is 15% lower with ticagrelor than with clopidogrel.
The findings, using data from patients enrolled in the SWEDEHEART registry, mirror those of the randomised PLATO trial, which was used as the basis for guidelines recommending the use of ticagrelor in ACS, say Anders Sahlén (Karolinska Institutet, Stockholm, Sweden) and co-researchers.
The rate of the primary composite outcome of all-cause mortality or readmission with MI or stroke was 11.7% among the 11,954 patients discharged on ticagrelor, compared with 22.3% among the 33,119 discharged on clopidogrel, which corresponds to an adjusted hazard ratio (HR) of 0.85.
The individual risks of death (5.8 vs 12.9%), MI (6.1 vs 10.8%) and stroke (1.8 vs 3.8%) were all lower with ticagrelor than with clopidogrel, but the difference was only statistically significant for death, at an adjusted HR of 0.83.
In contrast to the PLATO study, Sahlén and co-authors found that patients treated with ticagrelor were more likely to experience bleeding requiring hospitalisation than those treated with clopidogrel, at 5.5% versus 5.2%. And after adjustment for potential confounders, the bleeding risk was 20% higher with ticagrelor.
However, the researchers comment that it is “reassuring to note that while bleeding leading to readmission was indeed more frequently observed in real-world patients discharged on ticagrelor, the risk of death was lower.”
The likelihood of bleeding was also a significant 57% higher among the 11,221 ticagrelor-treated patients who underwent percutaneous coronary intervention (PCI) than among the 23,501 clopidogrel-treated patients who had the same procedure, at 3.7% versus 2.7%.
Further subgroup analysis showed that the ACS type (ST segment elevation MI [STEMI] vs non-STEMI) did not affect the association between ticagrelor treatment and patient outcomes.
Invasive strategy (PCI vs non-PCI) also had no effect on the primary outcome,
This differs from a subgroup analysis of PLATO data, which showed a benefit of ticagrelor among patients intended for conservative treatment, but Sahlén et al note that the non-PCI patients in PLATO were older, more often female and were more likely to have a history of coronary artery bypass grafting and stroke than those in SWEDEHEART.
“Any effect of ticagrelor may therefore have been influenced both by the disease burden of this subgroup and by selection bias”, they remark.
The study findings are published in the European Heart Journal.
By Laura Cowen
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