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

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@article{74342b06cfa74e7495e3278c3837b5c1,
title = "Clopidogrel, prasugrel, and ticagrelor for all-comers with ST-segment elevation myocardial infarction",
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, 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.",
keywords = "Clopidogrel, Prasugrel, ST-segment elevation myocardial infarction, Ticagrelor",
author = "Jacobsen, {Mia Ravn} and Thomas Engstr{\o}m and Christian Torp-Pedersen and Gunnar Gislason and Charlotte Glinge and Butt, {Jawad Haider} and Fosb{\o}l, {Emil Loldrup} and Lene Holmvang and Frants Pedersen and Lars K{\o}ber and Reza Jabbari and Rikke S{\o}rensen",
note = "Copyright {\textcopyright} 2021 The Author(s). Published by Elsevier B.V. All rights reserved.",
year = "2021",
month = nov,
day = "1",
doi = "10.1016/j.ijcard.2021.07.047",
language = "English",
volume = "342",
pages = "15--22",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

RIS

TY - JOUR

T1 - Clopidogrel, prasugrel, and ticagrelor for all-comers with ST-segment elevation myocardial infarction

AU - Jacobsen, Mia Ravn

AU - Engstrøm, Thomas

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar

AU - Glinge, Charlotte

AU - Butt, Jawad Haider

AU - Fosbøl, Emil Loldrup

AU - Holmvang, Lene

AU - Pedersen, Frants

AU - Køber, Lars

AU - Jabbari, Reza

AU - Sørensen, Rikke

N1 - Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

PY - 2021/11/1

Y1 - 2021/11/1

N2 - 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.

AB - 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.

KW - Clopidogrel

KW - Prasugrel

KW - ST-segment elevation myocardial infarction

KW - Ticagrelor

UR - http://www.scopus.com/inward/record.url?scp=85111945999&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2021.07.047

DO - 10.1016/j.ijcard.2021.07.047

M3 - Journal article

C2 - 34311012

VL - 342

SP - 15

EP - 22

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -

ID: 67986679