Abstract 15233: Impact of Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a Propensity Score-Matched Analysis of the Amis-Plus Registry
Objective: To investigate outcomes of patients treated with prasugrel or clopidogrel after percutaneous coronary intervention (PCI) in a nationwide acute coronary syndrome (ACS) registry.
Background: Prasugrel showed superior efficacy compared to clopidogrel in a randomized trial of ACS patients undergoing PCI. However, little is known about their efficacy in everyday practice.
Methods: All ACS patients undergoing PCI enrolled in the Swiss AMIS-Plus registry between January 2010 and December 2013 were included in this analysis. Patients were stratified according to treatment with prasugrel or clopidogrel and outcomes were compared using propensity score matching. The primary endpoint was a composite of death, recurrent infarction and stroke at hospital discharge.
Results: Out of 7’621 patients, 2’891 received prasugrel (38%) and 4’730 clopidogrel (62%). Independent predictors of in-hospital mortality were age, Killip class >2, STEMI, Charlson comorbidity index >1, and resuscitation prior to admission. After propensity score matching (2’301 patients per group), the primary endpoint was significantly lower in prasugrel-treated patients (3.0% vs. 4.3%; odds ratio (OR) 0.69 [95% CI 0.50-0.94], p=0.022) while bleeding events were more frequent (4.1% vs. 3.0%; OR 1.47 [1.06-2.02], p=0.048). In-hospital mortality was significantly reduced (1.8% vs. 3.1%; OR 0.56 [0.38-0.83], p=0.004), but no significant differences were observed in rates of recurrent infarction (0.8% vs. 0.7%; OR 1.06 [0.55-2.06], p=0.87) or stroke (0.5% vs. 0.6%; OR 0.86 [0.40-0.86], p=0.64). In a predefined subset of matched patients with one-year follow-up (n=1’226), mortality between hospital discharge and 1 year was not significantly reduced in prasugrel-treated patients (1.3% vs. 1.9%, OR 0.38 [0.08-1.94], p=0.38).
Conclusions: In a propensity score-matched analysis of the Swiss national ACS registry, prasugrel use was associated with reduced in-hospital mortality, despite a significant increase in bleeding complications. This suggests that prasugrel improves outcomes when used in appropriately selected ACS patients undergoing PCI.
- Acute coronary syndromes
- Antiplatelet drugs
- Percutaneous coronary intervention (PCI)
- Coronary artery disease
Author Disclosures: D.J. Kurz: None. D. Radovanovic: None. B. Seifert: None. A. Bernheim: None. M. Roffi: None. G. Pedrazzini: None. S. Windecker: None. P. Erne: None. F.R. Eberli: None.
- © 2014 by American Heart Association, Inc.