One-year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry

Background Prasugrel and ticagrelor have demonstrated higher efficacy than clopidogrel in their main clinical trials for patients with acute coronary syndrome (ACS). However, the long-term prognosis and different clinical characteristics related to the type of antiplatelet prescription in current cl...

Descripción completa

Detalles Bibliográficos
Autores: Ruiz-Nodar, JM, Esteve-Pastor, MA, Rivera-Caravaca, JM, Sandin, M, Lozano, T, Vicente-Ibarra, N, Orenes-Pinero, E, Macias, MJ, Pernias, V, Carrillo, L, Candela, E, Veliz, A, Tello-Montoliu, A, Martinez, JGM, Marin, F
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p9136
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/9136
Access Level:acceso abierto
Palabra clave:acute coronary syndrome
clopidogrel
myocardial infarction
prasugrel
ticagrelor
id ES_0688797f1e4daff3bb48b2de7ff8cb83
oai_identifier_str oai:fisabio.fundanetsuite.com:p9136
network_acronym_str ES
network_name_str España
repository_id_str
spelling One-year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registryRuiz-Nodar, JMEsteve-Pastor, MARivera-Caravaca, JMSandin, MLozano, TVicente-Ibarra, NOrenes-Pinero, EMacias, MJPernias, VCarrillo, LCandela, EVeliz, ATello-Montoliu, AMartinez, JGMMarin, Facute coronary syndromeclopidogrelmyocardial infarctionprasugrelticagrelorBackground Prasugrel and ticagrelor have demonstrated higher efficacy than clopidogrel in their main clinical trials for patients with acute coronary syndrome (ACS). However, the long-term prognosis and different clinical characteristics related to the type of antiplatelet prescription in current clinical practice ACS patients have not been analysed in depth. The objective of this study was to analyse the clinical profile of ACS and the efficacy and safety of novel oral P2Y(12) inhibitors in current clinical practice patients discharged afterACS. Methods We collected data from the ACHILLES registry, and an observational, prospective and multicentre registry of patients discharged after ACS. We analysed baseline characteristics, clinical profile and therapy during ACS admission and compared with the different treatments at discharge. After 1 year of follow-up, ischaemic and major bleeding events were analysed. Multivariate Cox regression analysis and Kaplan Meier curves were also plotted. Results Of 1717 consecutive patients, 1294 (75.4%) were discharged with a P2Y12 inhibitor without oral anticoagulation. Novel oral P2Y(12) inhibitors were indicated in 47%. Patients treated with clopidogrel were elderly (69.1 +/- 13.4 vs 60.4 +/- 11.5 years; P < .001) and had a higher prevalence of cardiovascular risk factors. GRACE and CRUSADE scores were higher in the clopidogrel than in novel oral P2Y(12) inhibitors group (P < .001). After 1 year of follow-up, 64(5.0%/year) patients had a new myocardial infarction, 127(10.0%/year) had a major adverse cardiovascular event (MACE) and 78(6.1%/year) died. Patients treated with clopidogrel had a significantly higher annual rate of cardiovascular mortality, MACE and all-cause mortality (allP < .001) without differences in major bleeding (P = .587) compared with novel oral P2Y(12) inhibitors. After multivariate adjustment for the main clinical variables related to adverse prognosis in ACS patients, the discharge with novel oral P2Y(12) inhibitors therapy was independently associated with lower risk of all-cause mortality (HR0.49, 95% CI [0.24-0.98], P = .044) and lower risk of MACE (HR0.64, 95% CI [0.41-0.98], P = .044). Conclusions In this prospective, observational and current clinical practice ACS registry, the use of novel oral P2Y(12) inhibitors was associated with a reduction in adverse events compared with clopidogrel in patients with ACS. Novel oral P2Y(12) inhibitors prescription at discharge was independently associated with lower all-cause mortality and MACE without differences in bleeding events. However, clopidogrel remained the most common P2Y12 inhibitor employed for ACS, especially in older and high-risk patients.WILEY2020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/9136BRITISH JOURNAL OF CLINICAL PHARMACOLOGYISSN: 03065251ISSNe: 13652125reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:fisabio.fundanetsuite.com:p91362026-06-11T12:45:17Z
dc.title.none.fl_str_mv One-year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry
title One-year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry
spellingShingle One-year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry
Ruiz-Nodar, JM
acute coronary syndrome
clopidogrel
myocardial infarction
prasugrel
ticagrelor
title_short One-year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry
title_full One-year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry
title_fullStr One-year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry
title_full_unstemmed One-year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry
title_sort One-year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry
dc.creator.none.fl_str_mv Ruiz-Nodar, JM
Esteve-Pastor, MA
Rivera-Caravaca, JM
Sandin, M
Lozano, T
Vicente-Ibarra, N
Orenes-Pinero, E
Macias, MJ
Pernias, V
Carrillo, L
Candela, E
Veliz, A
Tello-Montoliu, A
Martinez, JGM
Marin, F
author Ruiz-Nodar, JM
author_facet Ruiz-Nodar, JM
Esteve-Pastor, MA
Rivera-Caravaca, JM
Sandin, M
Lozano, T
Vicente-Ibarra, N
Orenes-Pinero, E
Macias, MJ
Pernias, V
Carrillo, L
Candela, E
Veliz, A
Tello-Montoliu, A
Martinez, JGM
Marin, F
author_role author
author2 Esteve-Pastor, MA
Rivera-Caravaca, JM
Sandin, M
Lozano, T
Vicente-Ibarra, N
Orenes-Pinero, E
Macias, MJ
Pernias, V
Carrillo, L
Candela, E
Veliz, A
Tello-Montoliu, A
Martinez, JGM
Marin, F
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv acute coronary syndrome
clopidogrel
myocardial infarction
prasugrel
ticagrelor
topic acute coronary syndrome
clopidogrel
myocardial infarction
prasugrel
ticagrelor
description Background Prasugrel and ticagrelor have demonstrated higher efficacy than clopidogrel in their main clinical trials for patients with acute coronary syndrome (ACS). However, the long-term prognosis and different clinical characteristics related to the type of antiplatelet prescription in current clinical practice ACS patients have not been analysed in depth. The objective of this study was to analyse the clinical profile of ACS and the efficacy and safety of novel oral P2Y(12) inhibitors in current clinical practice patients discharged afterACS. Methods We collected data from the ACHILLES registry, and an observational, prospective and multicentre registry of patients discharged after ACS. We analysed baseline characteristics, clinical profile and therapy during ACS admission and compared with the different treatments at discharge. After 1 year of follow-up, ischaemic and major bleeding events were analysed. Multivariate Cox regression analysis and Kaplan Meier curves were also plotted. Results Of 1717 consecutive patients, 1294 (75.4%) were discharged with a P2Y12 inhibitor without oral anticoagulation. Novel oral P2Y(12) inhibitors were indicated in 47%. Patients treated with clopidogrel were elderly (69.1 +/- 13.4 vs 60.4 +/- 11.5 years; P < .001) and had a higher prevalence of cardiovascular risk factors. GRACE and CRUSADE scores were higher in the clopidogrel than in novel oral P2Y(12) inhibitors group (P < .001). After 1 year of follow-up, 64(5.0%/year) patients had a new myocardial infarction, 127(10.0%/year) had a major adverse cardiovascular event (MACE) and 78(6.1%/year) died. Patients treated with clopidogrel had a significantly higher annual rate of cardiovascular mortality, MACE and all-cause mortality (allP < .001) without differences in major bleeding (P = .587) compared with novel oral P2Y(12) inhibitors. After multivariate adjustment for the main clinical variables related to adverse prognosis in ACS patients, the discharge with novel oral P2Y(12) inhibitors therapy was independently associated with lower risk of all-cause mortality (HR0.49, 95% CI [0.24-0.98], P = .044) and lower risk of MACE (HR0.64, 95% CI [0.41-0.98], P = .044). Conclusions In this prospective, observational and current clinical practice ACS registry, the use of novel oral P2Y(12) inhibitors was associated with a reduction in adverse events compared with clopidogrel in patients with ACS. Novel oral P2Y(12) inhibitors prescription at discharge was independently associated with lower all-cause mortality and MACE without differences in bleeding events. However, clopidogrel remained the most common P2Y12 inhibitor employed for ACS, especially in older and high-risk patients.
publishDate 2020
dc.date.none.fl_str_mv 2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/9136
url https://fisabio.portalinvestigacion.com/publicaciones/9136
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv WILEY
publisher.none.fl_str_mv WILEY
dc.source.none.fl_str_mv BRITISH JOURNAL OF CLINICAL PHARMACOLOGY
ISSN: 03065251
ISSNe: 13652125
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
instname_str Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869402923788664832
score 15,811543

Similares en LA Referencia