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Ticagrelor is Not Superior to Clopidogrel in Patients With Acute Coronary Syndromes Undergoing PCI: A Report from Swedish Coronary Angiography and Angioplasty Registry

BACKGROUND: Ticagrelor reduces ischaemic end points in acute coronary syndromes. However, outcomes of ticagrelor versus clopidogrel in real‐world patients with acute coronary syndromes treated with percutaneous coronary intervention (PCI) remain unclear. We sought to examine whether treatment with t...

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Autores principales: Völz, Sebastian, Petursson, Petur, Odenstedt, Jacob, Ioanes, Dan, Haraldsson, Inger, Angerås, Oskar, Dworeck, Christian, Hirlekar, Geir, Myredal, Anna, Albertsson, Per, Råmunddal, Truls, Redfors, Björn, Omerovic, Elmir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660716/
https://www.ncbi.nlm.nih.gov/pubmed/32662350
http://dx.doi.org/10.1161/JAHA.119.015990
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author Völz, Sebastian
Petursson, Petur
Odenstedt, Jacob
Ioanes, Dan
Haraldsson, Inger
Angerås, Oskar
Dworeck, Christian
Hirlekar, Geir
Myredal, Anna
Albertsson, Per
Råmunddal, Truls
Redfors, Björn
Omerovic, Elmir
author_facet Völz, Sebastian
Petursson, Petur
Odenstedt, Jacob
Ioanes, Dan
Haraldsson, Inger
Angerås, Oskar
Dworeck, Christian
Hirlekar, Geir
Myredal, Anna
Albertsson, Per
Råmunddal, Truls
Redfors, Björn
Omerovic, Elmir
author_sort Völz, Sebastian
collection PubMed
description BACKGROUND: Ticagrelor reduces ischaemic end points in acute coronary syndromes. However, outcomes of ticagrelor versus clopidogrel in real‐world patients with acute coronary syndromes treated with percutaneous coronary intervention (PCI) remain unclear. We sought to examine whether treatment with ticagrelor is superior to clopidogrel in unselected patients with acute coronary syndromes treated with PCI. METHODS AND RESULTS: We used data from SCAAR (Swedish Coronary Angiography and Angioplasty Registry) for PCI performed in Västra Götaland County, Sweden. The database contains information about all PCI performed at 5 hospitals (∼20% of all data in SCAAR). All procedures between January 2005 and January 2015 for unstable angina/non‒ST‐segment‒elevation myocardial infarction and ST‐segment‒elevation myocardial infarction were included. We used instrumental variable 2‐stage least squares regression to adjust for confounders. The primary combined end point was mortality or stent thrombosis at 30 days, secondary end points were mortality at 30 days and 1‐year, stent thrombosis at 30 days, in‐hospital bleeding, in‐hospital neurologic complications and long‐term mortality. A total of 15 097 patients were included in the study of which 2929 (19.4%) were treated with ticagrelor. Treatment with ticagrelor was not associated with a lower risk for the primary end point (adjusted odds ratio [aOR], 1.20; 95% CI, 0.87–1.61; P=0.250). Estimated risk of death at 30 days (aOR, 1.18; 95% CI, 0.88–1.64; P=0.287) and at 1‐year (aOR, 1.28; 95% CI, 0.86–1.64; P=0.556) was not different between the groups. The risk of in‐hospital bleeding was higher with ticagrelor (aOR, 2.88; 95% CI, 1.53–5.44; P=0.001). CONCLUSIONS: In this observational study, treatment with ticagrelor was not superior to clopidogrel in patients with acute coronary syndromes treated with PCI.
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spelling pubmed-76607162020-11-17 Ticagrelor is Not Superior to Clopidogrel in Patients With Acute Coronary Syndromes Undergoing PCI: A Report from Swedish Coronary Angiography and Angioplasty Registry Völz, Sebastian Petursson, Petur Odenstedt, Jacob Ioanes, Dan Haraldsson, Inger Angerås, Oskar Dworeck, Christian Hirlekar, Geir Myredal, Anna Albertsson, Per Råmunddal, Truls Redfors, Björn Omerovic, Elmir J Am Heart Assoc Original Research BACKGROUND: Ticagrelor reduces ischaemic end points in acute coronary syndromes. However, outcomes of ticagrelor versus clopidogrel in real‐world patients with acute coronary syndromes treated with percutaneous coronary intervention (PCI) remain unclear. We sought to examine whether treatment with ticagrelor is superior to clopidogrel in unselected patients with acute coronary syndromes treated with PCI. METHODS AND RESULTS: We used data from SCAAR (Swedish Coronary Angiography and Angioplasty Registry) for PCI performed in Västra Götaland County, Sweden. The database contains information about all PCI performed at 5 hospitals (∼20% of all data in SCAAR). All procedures between January 2005 and January 2015 for unstable angina/non‒ST‐segment‒elevation myocardial infarction and ST‐segment‒elevation myocardial infarction were included. We used instrumental variable 2‐stage least squares regression to adjust for confounders. The primary combined end point was mortality or stent thrombosis at 30 days, secondary end points were mortality at 30 days and 1‐year, stent thrombosis at 30 days, in‐hospital bleeding, in‐hospital neurologic complications and long‐term mortality. A total of 15 097 patients were included in the study of which 2929 (19.4%) were treated with ticagrelor. Treatment with ticagrelor was not associated with a lower risk for the primary end point (adjusted odds ratio [aOR], 1.20; 95% CI, 0.87–1.61; P=0.250). Estimated risk of death at 30 days (aOR, 1.18; 95% CI, 0.88–1.64; P=0.287) and at 1‐year (aOR, 1.28; 95% CI, 0.86–1.64; P=0.556) was not different between the groups. The risk of in‐hospital bleeding was higher with ticagrelor (aOR, 2.88; 95% CI, 1.53–5.44; P=0.001). CONCLUSIONS: In this observational study, treatment with ticagrelor was not superior to clopidogrel in patients with acute coronary syndromes treated with PCI. John Wiley and Sons Inc. 2020-07-14 /pmc/articles/PMC7660716/ /pubmed/32662350 http://dx.doi.org/10.1161/JAHA.119.015990 Text en © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Völz, Sebastian
Petursson, Petur
Odenstedt, Jacob
Ioanes, Dan
Haraldsson, Inger
Angerås, Oskar
Dworeck, Christian
Hirlekar, Geir
Myredal, Anna
Albertsson, Per
Råmunddal, Truls
Redfors, Björn
Omerovic, Elmir
Ticagrelor is Not Superior to Clopidogrel in Patients With Acute Coronary Syndromes Undergoing PCI: A Report from Swedish Coronary Angiography and Angioplasty Registry
title Ticagrelor is Not Superior to Clopidogrel in Patients With Acute Coronary Syndromes Undergoing PCI: A Report from Swedish Coronary Angiography and Angioplasty Registry
title_full Ticagrelor is Not Superior to Clopidogrel in Patients With Acute Coronary Syndromes Undergoing PCI: A Report from Swedish Coronary Angiography and Angioplasty Registry
title_fullStr Ticagrelor is Not Superior to Clopidogrel in Patients With Acute Coronary Syndromes Undergoing PCI: A Report from Swedish Coronary Angiography and Angioplasty Registry
title_full_unstemmed Ticagrelor is Not Superior to Clopidogrel in Patients With Acute Coronary Syndromes Undergoing PCI: A Report from Swedish Coronary Angiography and Angioplasty Registry
title_short Ticagrelor is Not Superior to Clopidogrel in Patients With Acute Coronary Syndromes Undergoing PCI: A Report from Swedish Coronary Angiography and Angioplasty Registry
title_sort ticagrelor is not superior to clopidogrel in patients with acute coronary syndromes undergoing pci: a report from swedish coronary angiography and angioplasty registry
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660716/
https://www.ncbi.nlm.nih.gov/pubmed/32662350
http://dx.doi.org/10.1161/JAHA.119.015990
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