Effectiveness of new antiplatelets in the prevention of recurrent myocardial infarction. Issue 19 (13th March 2018)

• Record Type: Journal Article
• Authors: Grimaldi-Bensouda, Lamiae; Danchin, Nicolas; Dallongeville, Jean; Falissard, Bruno; Furber, Alain; Cottin, Yves; Bonello, Laurent; Morel, Olivier; Leclercq, Florence; Puymirat, Etienne; Ghanem, Fahmi; Delarche, Nicolas; Benichou, Jacques; Abenhaim, Lucien
• Other Names: author non-byline.; Aarras Reda author non-byline.; Abdennbi Kamel author non-byline.; Akar Ramzi Abi author non-byline.; Eboule Corine Aboa author non-byline.; Adda Michel author non-byline.; Agbessi Fifa author non-byline.; Agout Bruno author non-byline.; Ahres Saïd author non-byline.; Aissou Linda author non-byline.; Albert Franck author non-byline.; Alexandre Joachim author non-byline.; Alies Alexandre author non-byline.; Allaouchiche Thierry author non-byline.; Amans Jean-Marc author non-byline.; Amara Walid author non-byline.; Amiar Ahmed author non-byline.; Oster Gladys Amiel author non-byline.; Amlaiky Ahmed author non-byline.; Amzallag Marc author non-byline.; Andrieu Stephane author non-byline.; Annic Jean Marie author non-byline.; Ansaldi Sébastien author non-byline.; Anton Cyprian author non-byline.; Ardouin Luc author non-byline.; Armero Sebastien author non-byline.; Assaf Abderrahmane author non-byline.; Attali Pierre author non-byline.; Audebert Gilles author non-byline.; 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• Is Part Of: Heart. Volume 104:Issue 19(2018)
• Page Start: 1583
• Page End: 1592
• Publication Date: 2018-03-13
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2017-312534
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: To compare ticagrelor and prasugrel with clopidogrel for recurrent fatal and non-fatal myocardial infarction (reMI) in real-life conditions. Methods: Case-referent study using the Pharmacoepidemiological General Research eXtension (PGRx)-acute coronary syndrome (ACS) registry. Cases were patients with reMI from a cohort with index ACS or external to the cohort (same sites). Referents from the cohort, without recurrent event, were matched on index ACS type and date, age and sex with reMI cases. Multivariate conditional logistic regression assessed the OR (95% CI) for reMI associated with ticagrelor and prasugrel vs clopidogrel, adjusted for aspirin use and cardiovascular risk factors. Results: 1047 cases and 2234 matched referents were included. Compared with clopidogrel, ticagrelor and prasugrel were associated with respective ORs of 0.65 (95% CI 0.52 to 0.81) and 0.71 (95% CI 0.53 to 0.96) for reMI occurrence. ORs for ticagrelor and prasugrel vs clopidogrel were: 0.50 (95% CI 0.38 to 0.67) and 0.66 (95% CI 0.45 to 0.95), 0.39 (95% CI 0.24 to 0.62) and 0.44 (95% CI 0.26 to 0.75), 0.63 (95% CI 0.43 to 0.92) and 1.20 (95% CI 0.69 to 2.07), 1.11 (95% CI 0.72 to 1.72) and 0.82 (95% CI 0.44 to 1.54) when index ACS was a first MI, a first ST-elevated MI (STEMI), a first non-STEMI and a recurrent ACS, respectively, and 0.63 (95% CI 0.45 to 0.87) and 0.77 (95% CI 0.41 to 1.45) for patients aged ≥70 years. Conclusions: This real-world study showed a significant reduction of reMI with new antiplatelets compared with clopidogrel, ticagrelor being associated with a greater decrease of risk notably for first, either STEMI or non-STEMI. The larger magnitude of effect may be attributed to potential residual confounding or higher effectiveness compared with efficacy reported in trials (EMA Post Authorisation Study Registry Number EUPAS5905).