Author + information
- Clemens von Birgelen1,
- Paolo Zocca2,
- Liefke van der Heijden1,
- Marlies Kok1,
- Martin Stoel1,
- Marc Hartmann1,
- Frits de Man3,
- J.Hans Louwerenburg4,
- Marije Lowik1,
- Iris Knottnerus2,
- Gerard C.M. Linssen5,
- Carine J.M. Doggen6 and
- K. Gert van Houwelingen7
- 1Thoraxcentrum Twente, Enschede, Netherlands
- 2Medisch Spectrum Twente, Enschede, Netherlands
- 3Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
- 4Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
- 5Ziekenhuis Groep Twente, Almelo and Hengelo, Almelo/Hengelo, Netherlands
- 6Department Health Technology and Services Research, MIRA, University of Twente, Enschede, Enschede, Netherlands
- 7Thoraxcentrum Twente, MST Enschede, Enschede, Netherlands
Acute coronary syndrome (ACS) guidelines have been changed, favoring dual antiplatelet therapy (DAPT) with more potent antiplatelet drugs (e.g. ticagrelor).
This investigator-initiated, observational study assessed at a Dutch high-volume PCI center the safety and efficacy of changing the primary DAPT regimen from clopidogrel- to ticagrelor-based DAPT in consecutive real-world ACS patients (no oral anticoagulation). Patients were treated with newer-generation drug-eluting stents (DES) from December 2012 to August 2015. On 1 May 2014 the primary DAPT regimen was changed.
Of 2,062 patients, 1,009(48.9%) were treated in the clopidogrel period and 1,053(51.1%) in the ticagrelor period (TP). TP patients were somewhat older, less often treated via femoral access, and received fewer GP-IIb/IIIa-inhibitors; 1-year follow-up was 99.3%. The primary endpoint Net Adverse Clinical and Cerebral Events (NACCE)–a composite of all-cause death, any myocardial infarction, stroke, or major bleeding– was higher in TP patients (5.1% vs.7.8%; HR 1.53 [95%-CI:1.08-2.17]; p=0.02). Assessment of non-inferiority was inconclusive (risk difference: 2.64 [95%-CI:0.52-4.77]; p=0.48). TP patients had higher major bleeding rates (1.2% vs.2.7%; p=0.02). Multivariate analysis confirmed higher NACCE (adj. HR 1.46 [95%-CI:1.02-2.07]; p=0.04) and major bleeding risks during TP (adj. HR 2.16 [95%-CI:1.09-4.24]; p=0.03).
In consecutive ACS patients treated with newer-generation DES, the guideline-suggested DAPT regimen did not improve the prevention of ischemic cardiovascular events but increased major bleeding risk.
CORONARY: Acute Coronary Syndromes