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Ticagelor is not superior to clopidogrel in patients with acute coronary syndrome: A report from SCAAR

Session Comorbidities and cardiomyopathies - How to manage?

Speaker Elmir Omerovic

Event : Heart Failure 2018

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease – Treatment
  • Session type : Rapid Fire Abstracts

Authors : E Omerovic (Gothenburg,SE)

Authors:
E Omerovic1 , 1Sahlgrenska University Hospital - Gothenburg - Sweden ,

Citation:

Background

The PLATO trial has shown that ticagrelor compared to clopidogrel improves survival and decreases risk for stent thrombosis in patients with acute coronary syndrome. The aim of this study was to investigate whether treatment with ticagrelor is superior to clopidogrel in patients with acute coronary syndrome in "real-world".

Methods

We used data from the SCAAR registry (Swedish Coronary Angiography and Angioplasty Registry) for the PCI procedures performed in Västra Götaland County in Sweden. The database contains information about all PCI procedures performed at five hospitals (~20% of all SCAAR data). All consecutive procedures between 2005 and 2015 for UA/NSTEMI and STEMI were included. We used multilevel modeling based on complete–case mixed-effects logistic regression to adjust for hierarchical database due to clustering of observations. The following variables were used for adjustment of risk estimates: age; gender; hypertension; hyperlipidemia; smoking status; diabetes; calendar year; indication for PCI; prior MI, CABG and/or PCI; cardiogenic shock; severity of coronary artery disease; number of implanted stents; completeness of revascularization; type of stent. The primary combined endpoint was death or stent thrombosis at 30 days. The secondary end points were death at 30-days, death at one-year and cardogenic shock.

Results

The total of 12,168 patients were included in the study of which 2,929 (19%) were treated with ticagrelor. 44% had STEMI. There were 555 events at 30-days of which 53 (9.5%) were stent thromboses. 844 patients were dead at one-year. Treatment with ticagrelor was not associated with lower risk for primary endpoint (OR 0.97; 95% CI 0.66 - 1.43; P=0.887). Estimated risk of death at 30-days (OR 1.02; 95% CI 0.59 - 1.76; P=0.937) and one-year (OR 1.01; 95% CI 0.68 - 1.47; P=0.992) was not different between the groups. We found no difference in risk of cardiogenic shock between the groups (OR 1.32; 95% CI 0.75 - 1.23; P=0.330)

Conclusions

In this observational study, treatment with ticagrelor was not superior to clopidogrel in patients with acute coronary syndrome treated with PCI.

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