Abstract 340: Thirty-day Repeat Hospitalizations for Patients Treated with Prasugrel Compared to Ticagrelor following Acute Coronary Syndrome: Findings from a Large Hospital Charge Master Database

Abstract

Background: This retrospective, real-world claims data base study in patients (pts) with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) demonstrated that prasugrel (pras) was non-inferior to ticagrelor (ticag) for 30 day safety and effectiveness outcomes. This report provides further evaluation between pras vs ticag of 30 day readmission rates for myocardial infarction (MI), revascularization (revasc), and bleeding. Methods: IMS Patient-Centric Data Warehouse claims data was used to identify ACS-PCI pts ≥18 years old with at least one in-hospital claim for pras or ticag between 8/1/11-4/30/13. The groups were propensity matched (PM) based upon demographic and clinical characteristics using index and prior hospitalization records dating back to 1/1/2008. Relative risk (RR) and 95% confidence interval (CI) were estimated to assess binary endpoints. Non-inferiority was computed by comparing the mean from a normal distribution of log (RR) with log (1.2), a predefined non-inferiority margin. Three cohorts were predefined: ACS-PCI (primary), ACS-PCI without prior TIA or stroke (label), ACS-PCI pts without prior TIA or stroke and if age ≥75 years with evidence of diabetes or prior MI (core). Results: Prior to PM, the primary cohort included 16,098 pts; 13,134 (82%) on pras, 2,964 (18 %) on ticag. Compared to pras, ticag pts were older, more often female, had increased cardiovascular risk factors, and more often treated at a teaching hospital. Unstable angina was seen more often in pras pts with no difference in STEMI or NSTEMI between the 2 groups. Using PM pts (table), pras was non-inferior to ticag in the primary cohort for rehosp for MI, revasc, and bleeding at 30 days post discharge. Rehosp for MI and bleeding was significantly lower with pras vs ticag while rehosp for revasc was lower, but not significantly. Results for the label and core cohorts had the same directionality as the primary cohort. Conclusion: Rehosp for MI, revasc or bleeding was non-inferior for pras compared to ticag at 30 days post discharge. Pts treated with pras had lower 30 day rehosp rates, particularly related to readmission for MI, compared with ticag. Although limited by selection bias, these results support the clinical utility of pras, regardless of cohort, to limit 30 day rehosp for pts undergoing PCI for ACS.