Author + information
- Rebecca Goslinga,b,
- Momina Yazdania,b,
- Yasir Parviza,b,
- Ian Halla,b,
- Ever Grecha,b,
- Julian Gunna,b,
- Robert Storeya,b and
- Javaid Iqbala,b
Background: We compared clopidogrel, prasugrel and ticagrelor, for mortality and stent thrombosis (ST) in patients with acute coronary syndromes (ACS).
Methods: Data were collected for 10,793 consecutive ACS patients undergoing coronary angiography at Sheffield, UK (2009–2015). Clopidogrel and ticagrelor were compared for all ACS patients and all three agents were compared in the STEMI subgroup. Difference in outcomes was evaluated at 12 months by KM curves and log-rank test after adjustment for independent risk factors.
Results: Of 10,793 patients with ACS (36% STEMI), 43% (4653) received clopidogrel, 11% (1223) prasugrel and 46% (4917) ticagrelor, with aspirin for all. In the overall group, ticagrelor (vs clopidogrel) was associated with lower all-cause mortality (Fig 1A). In the STEMI subgroup, both prasugrel and ticagrelor (vs clopidogrel) were associated with a lower mortality (Fig 1B). Of the 7,595 patients who underwent PCI, 78 (1%) had definite ST by 12 months. In the ACS cohort, patients treated with ticagrelor had a lower incidence of definite ST (C=1.1% vs T=0.6%, p=0.006). In the STEMI subgroup there was no significant difference between the three groups (C=1.5%, P=1.6%, T=1%, p=0.29).
Conclusions: Ticagrelor appears superior to clopidogrel for reduction in both mortality and ST in unselected ACS patients. In STEMI patients, both ticagrelor and prasugrel are associated with lower mortality compared with clopidogrel but there was no significant difference in the incidence of ST.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Considerations in Antiplatelet Therapy and in ACS
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1113-134
- 2017 American College of Cardiology Foundation