Comparative Effectiveness of Ticagrelor, Prasugrel, and Clopidogrel for Secondary Prophylaxis in Acute Coronary Syndrome: A Propensity Score-Matched Cohort Study.
Comparative Effectiveness of Ticagrelor, Prasugrel, and Clopidogrel for Secondary Prophylaxis in Acute Coronary Syndrome: A Propensity Score-Matched Cohort Study.
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DOI：
10.1002/cpt.2797
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发表时间：
2023-02
影响因子：
6.7
通讯作者：
Farley, Joel F.
中科院分区：
文献类型：
--
作者：
Kumar, Arun;Lutsey, Pamela L.;St Peter, Wendy L.;Schommer, Jon C.;Van't Hof, Jeremy R.;Rajpurohit, Abhijeet;Farley, Joel F.
在现实世界的美国人群中，急性冠脉综合征（ACS）后较新的P2 Y12抑制剂（普拉格雷和替格瑞洛）与氯吡格雷相比的有效性评价有限。本研究的目的是在真实患者环境中评估替格瑞洛、普拉格雷和氯吡格雷使用的心血管事件。这项回顾性队列研究使用IBM MarketScan数据库（2013年1月1日至2018年12月31日）创建了3个倾向评分匹配对：替格瑞洛与氯吡格雷（N= 21，719）、普拉格雷与氯吡格雷（N= 11，513）和普拉格雷与替格瑞洛（N= 11，065）。主要结局是心肌缺血、不稳定型心绞痛、卒中和心力衰竭住院的复合终点。在经皮冠状动脉介入治疗后开始使用P2 Y12抑制剂后30、90和180天时，在事件发生时间分析中比较这些组的主要结局。与氯吡格雷相比，替格瑞洛的使用表明90天时主要结局降低10%（HR 0.90，95%CI 0.82 - 0.99）。所有其他配对或随访组合均无差异。在女性亚组分析中，结果表明，与氯吡格雷相比，普拉格雷在30天时风险降低27%（HR 0.73，95% CI 0.53 1.00），替格瑞洛在90天时风险降低17%（HR 0.83，95% CI 0.70 0.98）。在接受裸金属支架治疗的患者中，结果表明普拉格雷与替格瑞洛相比，在30天和180天时主要结局的风险分别降低了55%和33%。由于美国比较这些药物的证据有限，这项研究有助于指导临床医生在ACS后选择P2 Y12抑制剂。
Comparative effectiveness evaluation of newer P2Y12 inhibitors (prasugrel and ticagrelor) compared to clopidogrel after acute coronary syndrome (ACS) is limited in real-world US populations. The objective of this study was to evaluate cardiovascular events based on ticagrelor, prasugrel, and clopidogrel use in a real-world patient setting. This retrospective cohort study used the IBM MarketScan database (January 1st, 2013, to December 31st, 2018) to create 3 propensity score-matched pairs: ticagrelor vs. clopidogrel (N=21,719), prasugrel vs. clopidogrel (N=11,513), and prasugrel vs. ticagrelor (N=11,065). The primary outcome was a composite of myocardial ischemia, unstable angina, stroke, and heart failure hospitalization. These groups were compared in a time-to-event analysis for the primary outcome at 30, 90, and 180 days following P2Y12 inhibitors initiation after percutaneous coronary intervention. Compared with clopidogrel, ticagrelor use suggested a 10% reduction in the primary outcome at 90 days (HR 0.90, 95% CI 0.82 0.99). There were no differences for all other matched pairs or follow-up combinations. In the subgroup analysis of females, the results suggested a risk reduction of 27% for prasugrel at 30 days (HR 0.73, 95% CI 0.53 1.00) and 17% for ticagrelor at 90 days (HR 0.83, 95% CI 0.70 0.98) when compared to clopidogrel. Among patients treated with bare-metal stents, the results suggested that prasugrel vs. ticagrelor was associated with a 55% and 33% reduced risk for the primary outcome at 30 days and 180 days, respectively. With limited evidence in the US comparing these drugs, this study helps inform clinicians when choosing P2Y12 inhibitors after ACS.
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影响因子：
20.1
作者：
Garcia M;Mulvagh SL;Merz CN;Buring JE;Manson JE
通讯作者：
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