Comparison of 1-year clinical outcomes between prasugrel and ticagrelor versus clopidogrel in type 2 diabetes patients with acute myocardial infarction underwent successful percutaneous coronary intervention

Abstract

Although the new oral P2Y12 inhibitors, prasugrel/ticagrelor have shown greater efficacy than clopidogrel in patients with the acute coronary syndrome, but they have not shown better efficacy in Korean patients. So we evaluated the efficacy of the prasugrel/ticagrelor in patients with myocardial infarction (MI) and diabetes, a more high-risk patients group.From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3985 patients with MI and diabetes who underwent PCI were enrolled between November 2011 and December 2015. The patients were divided into 2 groups: clopidogrel (n = 2985) and prasugrel/ticagrelor (n = 1000).After propensity score matching, prasugrel/ticagrelor group showed a no significant difference in risk of the composite of cardiac death (CD), recurrent MI or stroke (hazard ratio [HR], 0.705; 95% confidence interval [CI], 0.474-1.048; P = .084). However, the risk of major bleeding was significantly higher in the prasugrel/ticagrelor group. (HR; 2.114, 95% CI; [1.027-4.353], P = .042). In subgroup analysis, major bleeding was significantly increased in the subgroup of creatinine clearance <60 ml/min/1.73 m, hypertension, underwent a trans-femoral approach and diagnosed as NSTEMI among the prasugrel/ticagrelor group.The use of prasugrel/ticagrelor did not improve the composite of CD, recurrent MI or stroke, however, significantly increased major bleeding events in Korean patients with MI and diabetes undergoing PCI.

Figure 1

Study population flow chart. The patients with MI and diabetes who underwent PCI were enrolled. We excluded the patients occurred in-hospital switching between antiplatelet agents, those inappropriately used prasugrel, or those had missing data about antiplatelet agents or clinical outcomes. Total 3985 patients were enrolled. Among them, 2985 patients included clopidogrel group and 1000 patients included the prasugrel/ticagrelor group. MI = myocardial infarction, PCI = percutaneous coronary intervention.

Figure 2

Kaplan–Meier survival curve between clopidogrel and prasugrel/ticagrelor group in the propensity-matched cohort. (A) the composite of CD, recurrent MI or stroke, (B) the composite of CD, recurrent MI, stroke or major bleeding, (C) Major bleeding. The Kaplan–Meier curves presented the event rates for 1-year between clopidogrel and prasugrel/ticagrelor groups in the propensity-matched cohort. (A) showed the composite of CD, recurrent MI or stroke. (B) showed the composite of CD, recurrent MI, stroke or major bleeding. (C) showed major bleeding. There was no significant difference in the risk of the composite of CD, recurrent MI or stroke between 2 groups. However, the risk of the major bleeding was significantly higher in the prasugrel/ticagrelor group in the multivariate Cox regression analysis. CD = cardiac death, MI = myocardial infarction.