Abstract 17720: Comparison of Net Clinical Benefit With the Use of Newer Anti-Platelet Agents Between Transradial versus Transfemoral Percutaneous Interventions
Newer antiplatelet agents confer a significant reduction in major adverse cardiac events after percutaneous intervention (PCI), at the cost of increased bleeding. Clinical trials evaluating the safety and efficacy of these agents have used transfemoral (TF) approach as the predominant PCI approach. Use of transradial (TR) approach reduces procedural bleeding and alters the risk profile and net clinical benefit of these drugs
Methods: Markov modeling was used to calculate 1 year event free survival (EFS) probabilities for Prasugrel, Ticagrelor and Clopidogrel after TR PCI. These probabilities were compared against estimates derived for each agent after TF PCI. An event was defined as death, MI, stroke, revascularization, persistent angina or major bleeding
Results: With TR PCI, 1 year EFS was calculated as 84%, 83% and 81% for Prasugrel, Ticagrelor and Clopidogrel respectively. Corresponding estimates with TF PCI were 81%, 80% and 77% respectively. This difference was largely attributable to marked reduction in major bleeding with TR PCI. With TR PCI, 1 year major bleeding rates were estimated as 1.8%, 1.7% and 1.6% for Prasugrel, Ticagrelor and Clopidogrel respectively, compared to 7.4%, 7.1% and 6.0% with TF PCI respectively
Conclusions: A significant improvement in the net clinical benefit (evidenced by improvement in EFS) can be expected with Prasugrel or Ticagrelor over Clopidogrel with the use of TR PCI, primarily attributable to significantly reduced major bleeding complications with TR approach
- © 2013 by American Heart Association, Inc.