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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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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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. |
format | Online Article Text |
id | pubmed-8802857 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
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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