Better Outcomes with New P2Y12 Antiplatelet Agents in ACS Patients in Australia

Abstract

Objective: To determine the outcome of patients who received new P2Y12 antiplatelet agents (Ticagrelor or Prasugrel) compared with Clopidogrel following successful percutaneous intervention (PCI) for acute coronary syndrome (ACS). Methods: Retrospective analysis on patients undergoing successful PCI for ACS between January 2006 and June 2017. Follow-up was after one year with letter, phone call and file review. Results: 4941 patients (76% male) underwent successful PCI (57% BMS vs 43% DES) for ACS. In addition to aspirin, 87% of patients received Clopidogrel compared with 13% treated with new agents (mean age 64.4 and 59.3 years respectively). The use of new P2Y12 agents increased from 3.2% in 2010 to 28.5% in 2017. In 2017, new P2Y12 agents were used in 58% of STEMI, 32% of NSTEMI and 10% of unstable angina patients. Univariate analysis demonstrated that new P2Y12 agents were associated with lower incidence of death (2.44% vs 4.58% p = 0.01) and major adverse cardiac events (MACE) (7.46% vs 9.90% p = 0.04) but increased bleeding risk (BARC 2–3) (2.13% vs 1.05% p = 0.0176) at 1 year. There was no significant difference in myocardial infarction (2.74% vs 2.85% p = 0.87) or target lesion revascularisation (2.28% vs 3.13% p = 0.2). On multivariate analyses (including STEMI, cardiac arrest and shock), the new agents were an independent predictor of lower mortality (HR 1.85; 95%CI 1.11–3.28). Conclusions: The use of new P2Y12 agents in ACS was associated with lower mortality and MACE, but higher bleeding events. The higher bleeding rates with new P2Y12 agents may partly explain why these agents were under-utilised.