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Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark

BACKGROUND: Ticagrelor was introduced in Denmark in 2011 after randomised data showed its superiority over clopidogrel for patients with acute coronary syndrome (ACS). We assessed the effectiveness and safety of ticagrelor implementation in ACS patients undergoing percutaneous coronary intervention...

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Autores principales: Thrane, Pernille Gro, Olesen, Kevin Kris Warnakula, Würtz, Morten, Gyldenkerne, Christine, Madsen, Morten, Jensen, Lisette Okkels, Raungaard, Bent, Sørensen, Henrik Toft, Thim, Troels, Kristensen, Steen Dalby, Maeng, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8802857/
https://www.ncbi.nlm.nih.gov/pubmed/35146473
http://dx.doi.org/10.1016/j.lanepe.2021.100301
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author Thrane, Pernille Gro
Olesen, Kevin Kris Warnakula
Würtz, Morten
Gyldenkerne, Christine
Madsen, Morten
Jensen, Lisette Okkels
Raungaard, Bent
Sørensen, Henrik Toft
Thim, Troels
Kristensen, Steen Dalby
Maeng, Michael
author_facet Thrane, Pernille Gro
Olesen, Kevin Kris Warnakula
Würtz, Morten
Gyldenkerne, Christine
Madsen, Morten
Jensen, Lisette Okkels
Raungaard, Bent
Sørensen, Henrik Toft
Thim, Troels
Kristensen, Steen Dalby
Maeng, Michael
author_sort Thrane, Pernille Gro
collection PubMed
description BACKGROUND: Ticagrelor was introduced in Denmark in 2011 after randomised data showed its superiority over clopidogrel for patients with acute coronary syndrome (ACS). We assessed the effectiveness and safety of ticagrelor implementation in ACS patients undergoing percutaneous coronary intervention (PCI). METHODS: We identified PCI-treated ACS patients in Western Denmark who redeemed a P2Y12 inhibitor prescription within 14 days. Using Danish health registries, 1-year outcomes were compared before (2007-2010) and after (2012-2015) introduction of ticagrelor. Outcomes were MACE (death, myocardial infarction, and ischaemic stroke) and hospitalisation for bleeding. Inverse probability of treatment weights were used to estimate weighted incidence rate ratios (wIRRs). FINDINGS: We included 14,450 patients; 7,102 were treated in the earlier time period (99·9% clopidogrel) and 7,348 in the later time period (87·8% ticagrelor). Ticagrelor implementation was not associated with a clinically relevant difference in 1-year risk of MACE with 413 events in the ticagrelor period vs. 424 events in the clopidogrel period (cumulative incidence percentage [CIP] 5·6% vs. 6·0%; wIRR 1·06, 95% CI 0·92-1·22). The 1-year risk of bleeding was also similar between groups with 335 bleedings requiring hospitalisation in the ticagrelor period vs. 309 events in the clopidogrel period (CIP 4·6% vs. 4·4%; wIRR 1·05, 95% CI 0·89-1·23). Results were robust in patients above and below 70 years of age. INTERPRETATION: Implementation of ticagrelor was not associated with changes in risks of ischaemic or bleeding events in Danish PCI-treated ACS patients.
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spelling pubmed-88028572022-02-09 Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark Thrane, Pernille Gro Olesen, Kevin Kris Warnakula Würtz, Morten Gyldenkerne, Christine Madsen, Morten Jensen, Lisette Okkels Raungaard, Bent Sørensen, Henrik Toft Thim, Troels Kristensen, Steen Dalby Maeng, Michael Lancet Reg Health Eur Articles BACKGROUND: Ticagrelor was introduced in Denmark in 2011 after randomised data showed its superiority over clopidogrel for patients with acute coronary syndrome (ACS). We assessed the effectiveness and safety of ticagrelor implementation in ACS patients undergoing percutaneous coronary intervention (PCI). METHODS: We identified PCI-treated ACS patients in Western Denmark who redeemed a P2Y12 inhibitor prescription within 14 days. Using Danish health registries, 1-year outcomes were compared before (2007-2010) and after (2012-2015) introduction of ticagrelor. Outcomes were MACE (death, myocardial infarction, and ischaemic stroke) and hospitalisation for bleeding. Inverse probability of treatment weights were used to estimate weighted incidence rate ratios (wIRRs). FINDINGS: We included 14,450 patients; 7,102 were treated in the earlier time period (99·9% clopidogrel) and 7,348 in the later time period (87·8% ticagrelor). Ticagrelor implementation was not associated with a clinically relevant difference in 1-year risk of MACE with 413 events in the ticagrelor period vs. 424 events in the clopidogrel period (cumulative incidence percentage [CIP] 5·6% vs. 6·0%; wIRR 1·06, 95% CI 0·92-1·22). The 1-year risk of bleeding was also similar between groups with 335 bleedings requiring hospitalisation in the ticagrelor period vs. 309 events in the clopidogrel period (CIP 4·6% vs. 4·4%; wIRR 1·05, 95% CI 0·89-1·23). Results were robust in patients above and below 70 years of age. INTERPRETATION: Implementation of ticagrelor was not associated with changes in risks of ischaemic or bleeding events in Danish PCI-treated ACS patients. Elsevier 2022-01-25 /pmc/articles/PMC8802857/ /pubmed/35146473 http://dx.doi.org/10.1016/j.lanepe.2021.100301 Text en © 2021 Published by Elsevier Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Articles
Thrane, Pernille Gro
Olesen, Kevin Kris Warnakula
Würtz, Morten
Gyldenkerne, Christine
Madsen, Morten
Jensen, Lisette Okkels
Raungaard, Bent
Sørensen, Henrik Toft
Thim, Troels
Kristensen, Steen Dalby
Maeng, Michael
Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark
title Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark
title_full Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark
title_fullStr Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark
title_full_unstemmed Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark
title_short Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark
title_sort effectiveness and safety of ticagrelor implementation in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a cohort study in western denmark
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8802857/
https://www.ncbi.nlm.nih.gov/pubmed/35146473
http://dx.doi.org/10.1016/j.lanepe.2021.100301
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