REAL-WORLD CLINICAL OUTCOMES ACCORDING TO DUAL ANTI-PLATELET THERAPY REGIMEN AMONG PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: SINGLE CENTER EXPERIENCE IN CANADA

Abstract

Newer anti-P2Y12 inhibitors (i.e. ticagrelor and prasugrel) have demonstrated superiority over clopidogrel in the setting of acute coronary syndromes (ACS) in randomized controlled trials. However such results have not been reported in routine clinical practice. Data were systematically and prospectively collected in our institutional interventional database between April 1st 2013 and March 30th 2014. We analyzed in-hospital outcomes of patients undergoing PCI on the basis of different dual anti-platelet therapy (DAPT) regimens consisting in clopidogrel versus ticagrelor or prasugrel in addition to aspirin. Over the study period, 1835 patients were included: 333 were treated with BVS, 1009 with DES and 490 with BMS. In addition to aspirin, patients were pre-treated with clopidogrel in 65% of the cases and ticagrelor or prasugrel in 35%. In-hospital MACE (death, myocardial infarction or urgent PCI) occurred in 1.2% of the patients on ticagrelor or prasugrel and in 3.0% of the patients on clopidogrel (HR=2.49; 95% CI [1.1-5.7]; p=0.03). Sub-group analysis of patients with ACS showed also a significantly lower incidence of MACE in patients pre-treated with ticagrelor of prasugrel (HR=2.54; 95% CI [1-6,3]; p=0.049) When considering only patients treated with drug-eluting devices (i.e. BVS or metallic DES) and after logistic regression modeling, treatment with ticagrelor or prasugrel versus clopidogrel was independently associated with a lower incidence of in-hospital MACE (HR=3.29 [1.25-8.66]; p=0.016). There was no significant correlation between the type of drug eluting device used and the incidence of MACE. In this contemporary, real-world all-comer patient population treated with PCI, using multiple types of stents in a real-life context; DAPT regimen with ticagrelor or prasugrel pre-treatment in addition to aspirin was associated with a significantly lower incidence of in-hospital MACE among patients undergoing PCI as compared with clopidogrel.