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Observational Study
. 2020 Nov;50(11):e13304.
doi: 10.1111/eci.13304. Epub 2020 Sep 9.

Ticagrelor and prasugrel are independent predictors of improved long-term survival in ACS patients

Gloria M Gager  1   2 , Bernd Jilma  1 , Max-Paul Winter  2 , Christian Hengstenberg  2 , Irene M Lang  2 , Aurel Toma  2 , Florian Prüller  3 , Markus Wallner  4   5   6 , Ewald Kolesnik  4 , Dirk von Lewinski  4 , Jolanta M Siller-Matula  2   7
Affiliations
Observational Study

Ticagrelor and prasugrel are independent predictors of improved long-term survival in ACS patients

Gloria M Gager et al. Eur J Clin Invest. 2020 Nov.

Abstract

Aim: To investigate the long-term clinical benefit of dual antiplatelet therapy with potent P2Y12 inhibitors compared to clopidogrel in patients with acute coronary syndrome (ACS).

Methods: In this prospective multicenter observational study, we enrolled 708 patients with ACS treated with clopidogrel (n = 137), ticagrelor (n = 260) or prasugrel (n = 311). Major adverse cardiac events (MACE; over 1 year) and long-term mortality (median: 5.6 years; interquartile range [IQR] 4.9-6.5 years) were assessed. Multiple electrode aggregometry (MEA) was used to measure adenosine diphosphate (ADP)- and arachidonic acid (AA)-induced platelet aggregation.

Results: Type of P2Y12 inhibitor emerged as an independent predictor of long-term mortality and MACE: patients treated with potent platelet inhibitors prasugrel or ticagrelor were at lower risk for long-term mortality (adjusted hazard ratio [HR] = 0.44; 95% CI: 0.22-0.92; P = .028) or MACE (adjusted HR = 0.38; 95% CI: 0.20-0.73; P = .004) than those treated with clopidogrel independent from clinical risk factors. In contrast, the efficacy of clopidogrel decreased with increasing severity of ACS: platelet aggregation was 37% higher in patients with ST segment elevation myocardial infarction (STEMI) and 25% higher in patients with non-ST elevation myocardial infarction (non-STEMI) compared to patients with unstable angina (P = .039). Patients with diabetes achieved less potent ADP- and AA-induced platelet inhibition under clopidogrel, compared to patients without diabetes (P = .045; P = .030, respectively).

Conclusion: In the setting of ACS, treatment with ticagrelor or prasugrel reduced long-term mortality and 1-year MACE as compared to clopidogrel.

Keywords: MEA; clopidogrel; mortality; platelets; prasugrel; ticagrelor.

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Figures

FIGURE 1
FIGURE 1
Adenosine diphosphate (ADP)‐induced platelet aggregation assessed by multiple electrode aggregometry in relation to (A) the type of ADP inhibitor and (B) diagnosis at hospitalization
FIGURE 2
FIGURE 2
(A) ADP‐induced and (B) arachidonic acid (AA)‐induced platelet aggregation in regard to type of ADP inhibitor and status of diabetes
FIGURE 3
FIGURE 3
(A) Chi‐squared automatic interaction detection (CHAID) for predictors of MACE; (B) Kaplan‐Meier survival analysis for MACE
FIGURE 4
FIGURE 4
(A) Chi‐squared automatic interaction detection (CHAID) for predictors of long‐term mortality; (B) Kaplan‐Meier survival analysis for long‐term mortality
See this image and copyright information in PMC

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References

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