Real World Outcomes of Prasugrel and Ticagrelor Versus Clopidogrel in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention

MENTOR AND COLLABORATORS: Andres Guerra, Henry Han, Alan Sosa, Georgios Christopoulos, Muhammad Nauman Tarar, Kevin Kelly, Rick Weideman, Michele Roesle, Bavana V. Rangan, Subhash Banerjee, Emmanouil S. Brilakis, MD, PhD Department of Internal Medicine- Cardiology, University of Texas Southwestern Medical Center & VA North Texas Healthcare System BACKGROUND: ADP P2Y12 inhibitors are routinely administered after percutaneous coronary intervention (PCI) to prevent stent thrombosis. The newer P2Y12 inhibitors, prasugrel and ticagrelor, reduced the incidence of major adverse cardiac events (MACE) compared with clopidogrel in clinical trials of acute coronary syndrome (ACS) patients, but have received limited study in routine clinical practice. OBJECTIVE: To compare the outcomes of prasugrel and ticagrelor with clopidogrel in real world ACS patients undergoing PCI. METHODS: The medical records of all patients who underwent PCI at our institution between January 2011 and November 2013 were reviewed. The 12- month incidence of MACE (death, myocardial infarction, and repeat coronary revascularization) and bleeding was compared between patients who received a novel P2Y12 inhibitor (prasugrel or ticagrelor) and a random sample of those who received clopidogrel. RESULTS : Two hundred and one patients who underwent PCI for ACS were included: 80 received either prasugrel or ticagrelor and 121 received clopidogrel. Mean age was 63.7 ± 9.3 years and 99% of the patients were men. The two study groups had similar baseline characteristics. The 12-month incidence of MACE in the novel P2Y12 inhibitor subgroup was 23% versus 33% in the clopidogrel subgroup (p = 0.25). Patients receiving prasugrel or ticagrelor had lower incidence of all cause (p < 0.01) and cardiac (p = 0.05) death, and similar incidence of bleeding. CONCLUSION: In a non-selected ACS population use of a novel P2Y12 inhibitor was associated with lower incidence of death and similar incidence of bleeding as compared with clopidogrel.