Abstract 15418: Contemporary Use of Ticagrelor in Interventional Practice: Insights From BMC2
Background: Ticagrelor, like prasugrel, has enhanced anti-ischemic efficacy and increased bleeding compared with clopidogrel and has been approved for patients with acute coronary syndromes (ACS). There are no data on the contemporary use of ticagrelor.
Objectives: To determine use of ticagrelor in clinical practice.
Methods: We assessed the use of ticagrelor in 43,167 patients who had percutaneous coronary intervention (PCI) and were discharged from October 2011 to December 2012 at 47 Michigan hospitals in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) registry. Pre-procedural risk of major adverse events was estimated with BMC2 risk prediction models using baseline characteristics.
Results: The proportion of patients receiving clopidogrel, prasugrel, and ticagrelor was 75.7% (n=32,678), 21.7% (n=9,380), and 2.6% (n=1,109) respectively. Ticagrelor was used at 32 hospitals; its use ranged from 0.5% to 15.9 % of total discharges. Compared with patients on prasugrel, those on ticagrelor tended to be female, older, and white (table). A higher proportion of patients on ticagrelor had a history of CABG, presented with STEMI or equivalent, cardiac arrest within 24 hours, and required intra-aortic balloon pump (IABP). Compared with prasugrel, the predicted risk of contrast nephropathy (2.6% vs. 1.6%), transfusion (4.6% vs. 3.5%), and death (1.3% vs. 0.6%) was higher for ticagrelor (p <0 .001 for all). Nearly 20% of patients were given prasugrel or ticagrelor for a non-ACS indication.
Conclusion: Ticagrelor use is low for patients undergoing PCI. Compared to prasugrel, ticagrelor is prescribed to a less stable, higher risk population, and 1 in 5 patients on ticagrelor did not have ACS.
- © 2013 by American Heart Association, Inc.