Dr. Mia Ravn Jacobsen, M.D. is a Corresponding Author at Rigshospitalet, Copenhagen University Hospital - Aalborg University Hospital's Department of Cardiology.
Link to Abstract: https://www.internationaljournalofcardiology.com/article/S0167-5273(21)01192-X/fulltext#%20
To assess the efficacy and safety of clopidogrel, prasugrel, and ticagrelor in people who have had an ST-segment elevation myocardial infarction (STEMI) and to expand on what has been learned from randomized clinical studies.
The Eastern Danish Heart Registry was used to identify all consecutive STEMI patients admitted to Copenhagen University Hospital, Rigshospitalet, between 2009 and 2016. Claim medicines and end points were gathered through individual linkage to Danish national registers. Patients alive a week after discharge were included in the study, and they were divided into three groups based on whether they were taking clopidogrel, prasugrel, or ticagrelor. They were then monitored for a year. Multivariate Cox proportional-hazards models were used to analyze the effectiveness end point (a composite of all-cause mortality, recurrent myocardial infarction, and ischemic stroke) and the safety end point (a composite of bleedings resulting to hospitalization).
A total of 5123 patients (clopidogrel , prasugrel , ticagrelor ) were enrolled in the study, with a 95 percent therapy persistency rate. Aspirin was taken at the same time in 95% of the cases. Females made up 24% of the population, while the elderly made up 17%. The efficacy endpoint occurred less frequently for ticagrelor (HR 0.50, 95 percent CI 0.35–0.70) and prasugrel (HR 0.48, 95 percent CI 0.33–0.68) as compared to clopidogrel, with no differences in bleedings requiring hospitalization. Prasugrel and ticagrelor have no differences in comparative effectiveness or safety. Similar results were found in sensitivity analyses using time-dependent drug exposure for the years 2011–2015.
When compared to clopidogrel, ticagrelor and prasugrel were linked with a lower incidence of all-cause mortality, recurrent myocardial infarction, and ischemic stroke in STEMI patients without an increase in bleeding that required hospitalization. There were no differences between prasugrel and ticagrelor.