PCV24 - SAFETY AND EFFECTIVENESS OF CONTEMPORARY P2Y12 INHIBITORS IN EAST ASIAN PATIENTS WITH ACUTE CORONARY SYNDROMES: A NATIONWIDE POPULATION-BASED COHORT STUDY

Abstract

To evaluate the safety and effectiveness of potent P2Y12 inhibitors ticagrelor and prasugrel compared to clopidogrel in East Asian patients with acute coronary syndromes (ACS). In an observational national cohort study using administrative claims-based datasets, we compared safety and effectiveness outcomes in patients with ACS who initiated P2Y12 inhibitors between January 1, 2013, and November 30, 2015. The primary safety outcomes were any bleeding and major bleeding, and the primary effectiveness outcomes were major cardiovascular events (a composite of cardiovascular death, myocardial infarction or stroke) and all-cause mortality. Among 70,715 eligible patients with ACS, 56,216 (79.5%) used clopidogrel, 11,402 (16.1%) used ticagrelor, and 3,097 (4.4%) used prasugrel. The median follow-up period was 18.0 months (interquartile range, 9.6–26.4 months). In a propensity-matched cohort, as compared with clopidogrel, ticagrelor was associated with a higher risk of any bleeding (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.21–1.41) and major bleeding (HR 1.25, 95% CI 1.04–1.51), but a similar risk of major cardiovascular events (HR 0.98, 95% CI 0.90–1.07) and a lower risk of mortality (HR 0.80, 95% CI 0.67–0.96). Prasugrel, as compared with clopidogrel, was associated with a higher risk of any bleeding (HR 1.22, 95% CI 1.05–1.42), but a borderline benefit of major cardiovascular events (HR 0.84, 95% CI 0.71–1.00) and a similar risk of major bleeding and mortality. There was no significant difference between ticagrelor and prasugrel in terms of any safety or effectiveness outcomes. In a contemporary clinical-practice of East Asian patients with ACS, compared to clopidogrel, ticagrelor was associated with an increased risk of bleeding but a decreased risk of mortality. Prasugrel was associated with an increase of any bleeding but a borderline clinical benefit for reduction of major cardiovascular events. The risks of bleeding and ischemic events were similar between ticagrelor and prasugrel.