Abstract 14994: A Propensity Score Analysis of Early and Long-Term Outcomes After Ticagrelor or Clopidogrel in Elderly Patients With Acute Myocardial Infarction: The Fast-MI 2015 Registry

Abstract

Introduction: Guidelines recommend ticagrelor (T) over clopidogrel (C) in AMI patients, irrespective of age. Real-world evidence in the very elderly is limited. Question: Whether T is superior to C for elderly patients regarding early and long-term outcomes in real-life conditions. Goal: To analyze in-hospital, one- and 5-year outcomes according to use of T or C in AMI patients ≥80 yo. Methods: FAST-MI 2015 included consecutive AMI patients over 1 month in 204 French centers. Patients ≥80 yo, receiving C or T ≤48 hours of admission were studied. Propensity scores (PS) for receiving T or C was used in multivariable analyses and for PS matching. Results: Of 5291 patients in the registry, 995 (19%) were ≥80 yo, of whom 870 (87%) met the inclusion criteria. Mean age was 85±4 years (86 ± 4 for C-treated; 84±3 for T-treated), 51% were women (50.5% and 53% respectively for C and T), and 40% had STEMI (33% and 49% respectively). PS-adjusted HRs for T vs C were 1.26, 95%CI 0.65-2.44 for 30-day death, 1.09, 95% CI 0.71-1.67 for death at one year and 0.86, 95% CI 0.67-1.11 at 5 years. After PS matching, the two cohorts (N=293 each) were well balanced for all baseline characteristics including medications given at the acute stage. In-hospital complications, including major bleeding, re-MI, stroke and death were similar for T and C. Thirty-day, one-year, and 5-year mortality were similar for the 2 medications, with a trend favouring T over time, suggesting the possibility of undetected confounders (Figure). In hospital survivors, however, T at discharge was associated with improved 5-year survival (PS-adjusted HR 0.64, 95%CI 0.46-0.90), compared with C. Conclusions: In this real-world population of elderly (mean age 85 years) patients with AMI, initial use of ticagrelor was not associated with improved survival, compared with clopidogrel. In hospital survivors, however, ticagrelor at discharge was associated with reduced long-term mortality.