Kurz, David J; Radovanovic, Dragana; Seifert, Burkhardt; Bernheim, Alain M; Roffi, Marco; Pedrazzini, Giovanni; Windecker, Stephan; Erne, Paul; Eberli, Franz R (2016). Comparison of prasugrel and clopidogrel-treated patients with acute coronary syndrome undergoing percutaneous coronary intervention: A propensity score-matched analysis of the Acute Myocardial Infarction in Switzerland (AMIS)-Plus Registry. European Heart Journal: Acute Cardiovascular Care, 5(1), pp. 13-22. Sage 10.1177/2048872614566946
Full text not available from this repository. (Request a copy)OBJECTIVE
The purpose of this study was to investigate outcomes of patients treated with prasugrel or clopidogrel after percutaneous coronary intervention (PCI) in a nationwide acute coronary syndrome (ACS) registry.
BACKGROUND
Prasugrel was found to be superior to clopidogrel in a randomized trial of ACS patients undergoing PCI. However, little is known about its efficacy in everyday practice.
METHODS
All ACS patients enrolled in the Acute Myocardial Infarction in Switzerland (AMIS)-Plus registry undergoing PCI and being treated with a thienopyridine P2Y12 inhibitor between January 2010-December 2013 were included in this analysis. Patients were stratified according to treatment with prasugrel or clopidogrel and outcomes were compared using propensity score matching. The primary endpoint was a composite of death, recurrent infarction and stroke at hospital discharge.
RESULTS
Out of 7621 patients, 2891 received prasugrel (38%) and 4730 received clopidogrel (62%). Independent predictors of in-hospital mortality were age, Killip class >2, STEMI, Charlson comorbidity index >1, and resuscitation prior to admission. After propensity score matching (2301 patients per group), the primary endpoint was significantly lower in prasugrel-treated patients (3.0% vs 4.3%; p=0.022) while bleeding events were more frequent (4.1% vs 3.0%; p=0.048). In-hospital mortality was significantly reduced (1.8% vs 3.1%; p=0.004), but no significant differences were observed in rates of recurrent infarction (0.8% vs 0.7%; p=1.00) or stroke (0.5% vs 0.6%; p=0.85). In a predefined subset of matched patients with one-year follow-up (n=1226), mortality between discharge and one year was not significantly reduced in prasugrel-treated patients (1.3% vs 1.9%, p=0.38).
CONCLUSIONS
In everyday practice in Switzerland, prasugrel is predominantly used in younger patients with STEMI undergoing primary PCI. A propensity score-matched analysis suggests a mortality benefit from prasugrel compared with clopidogrel in these patients.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Windecker, Stephan |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2048-8734 |
Publisher: |
Sage |
Language: |
English |
Submitter: |
Judith Liniger |
Date Deposited: |
25 Feb 2016 09:05 |
Last Modified: |
05 Dec 2022 14:51 |
Publisher DOI: |
10.1177/2048872614566946 |
PubMed ID: |
25614494 |
Uncontrolled Keywords: |
Acute coronary syndrome; percutaneous coronary intervention; platelet aggregation inhibitors; propensity score; thienopyridines |
URI: |
https://boris.unibe.ch/id/eprint/75949 |
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