Abstract | AIMS: METHODS AND RESULTS: We studied 11,999 myocardial infarction patients treated with percutaneous coronary intervention at 230 hospitals from April 2010 to October 2012 in the TRANSLATE-ACS study. Multivariable Cox regression was used to compare six-month post-discharge risks of major adverse cardiovascular events ( MACE: death, myocardial infarction, stroke, or unplanned revascularization) and Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-defined bleeding between in-hospital ADP receptor inhibitor switching versus continuation of the initially selected therapy. Among 8715 patients treated initially with clopidogrel, 994 (11.4%) were switched to prasugrel or ticagrelor; switching occurred primarily after percutaneous coronary intervention (60.9%) and at the time of hospital discharge (26.7%). Among 3284 patients treated initially with prasugrel or ticagrelor, 448 (13.6%) were switched to clopidogrel; 48.2% of switches occurred after percutaneous coronary intervention and 48.0% at hospital discharge. Switching to prasugrel or ticagrelor was not associated with increased bleeding when compared with continuation on clopidogrel (2.7% vs. 3.3%, adjusted hazard ratio 0.96, 95% confidence interval 0.64-1.42, p=0.82). Switching from prasugrel or ticagrelor to clopidogrel was not associated with increased MACE (8.9% vs. 7.7%, adjusted hazard ratio 1.06, 95% confidence interval 0.75-1.49, p=0.76) when compared with continuation on the higher potency agent. CONCLUSIONS:
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Authors | Akshay Bagai, Eric D Peterson, Emily Honeycutt, Mark B Effron, David J Cohen, Shaun G Goodman, Kevin J Anstrom, Anjan Gupta, John C Messenger, Tracy Y Wang |
Journal | European heart journal. Acute cardiovascular care
(Eur Heart J Acute Cardiovasc Care)
Vol. 4
Issue 6
Pg. 499-508
(Dec 2015)
ISSN: 2048-8734 [Electronic] England |
PMID | 25515725
(Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
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Copyright | © The European Society of Cardiology 2014. |
Chemical References |
- Platelet Aggregation Inhibitors
- Purinergic P2Y Receptor Antagonists
- Clopidogrel
- Prasugrel Hydrochloride
- Ticagrelor
- Adenosine
- Ticlopidine
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Topics |
- Adenosine
(analogs & derivatives, therapeutic use)
- Aged
- Clopidogrel
- Drug Substitution
(adverse effects, statistics & numerical data)
- Female
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Myocardial Infarction
(drug therapy, surgery)
- Patient Discharge
(statistics & numerical data)
- Percutaneous Coronary Intervention
(methods)
- Platelet Aggregation Inhibitors
(therapeutic use)
- Prasugrel Hydrochloride
(therapeutic use)
- Proportional Hazards Models
- Purinergic P2Y Receptor Antagonists
(adverse effects, therapeutic use)
- Ticagrelor
- Ticlopidine
(analogs & derivatives, therapeutic use)
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