Yudi M B, Clark D J, Farouque O, Eccleston D, Andrianopoulos N, Duffy S J, Brennan A, Lefkovits J, Ramchand J, Yip T, Oqueli E, Reid C M, Ajani A E
Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
The University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2016 May;46(5):559-65. doi: 10.1111/imj.13041.
Guidelines recommend prasugrel or ticagrelor instead of clopidogrel in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary interventions (PCI).
We sought to describe the trends in uptake of the newer agents and analyse the clinical characteristics and short-term outcomes of patients treated with clopidogrel, prasugrel or ticagrelor.
We analysed the temporal trends of antiplatelet use since the availability of prasugrel (2009-2013) in patients with ACS from the Melbourne Interventional Group registry. To assess clinical characteristics and outcomes, we included 1850 patients from 2012 to 2013, corresponding to the time all three agents were available. The primary outcome was major adverse cardiovascular events (MACE). The safety end-point was in-hospital bleeding.
For the period of 2009-2013, the majority of patients were treated with clopidogrel (72%) compared with prasugrel (14%) or ticagrelor (14%). There was a clear trend towards ticagrelor by the end of 2013. Patients treated with clopidogrel were more likely to present with non-ST-elevation ACS, be older, and have more comorbidities. There was no difference in unadjusted 30-day mortality (0.9 vs 0.5 vs 1.0%, P = 0.76), myocardial infarction (2 vs 1 vs 2%, P = 0.52) or MACE (3 vs 3 vs 4%, P = 0.57) between the three agents. There was no difference in in-hospital bleeding (3 vs 2 vs 2%, P = 0.64).
Prasugrel and ticagrelor are increasingly used in ACS patients treated with PCI, predominantly in a younger cohort with less comorbidity. Although antiplatelet therapy should still be individualised based on the thrombotic and bleeding risk, our study highlights the safety of the new P2Y12 inhibitors in contemporary Australian practice.
指南推荐在接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者中使用普拉格雷或替格瑞洛而非氯吡格雷。
我们试图描述新型药物的使用趋势，并分析接受氯吡格雷、普拉格雷或替格瑞洛治疗的患者的临床特征和短期结局。
我们分析了自普拉格雷上市（2009 - 2013年）以来，墨尔本介入组登记处ACS患者抗血小板药物使用的时间趋势。为评估临床特征和结局，我们纳入了2012年至2013年期间的1850例患者，这一时期三种药物均已上市。主要结局是主要不良心血管事件（MACE）。安全终点是住院期间出血。
在2009 - 2013年期间，大多数患者接受氯吡格雷治疗（72%），相比之下，接受普拉格雷治疗的患者占14%，接受替格瑞洛治疗的患者占14%。到2013年底，替格瑞洛的使用呈明显上升趋势。接受氯吡格雷治疗的患者更可能表现为非ST段抬高型ACS，年龄更大，合并症更多。三种药物在未调整的30天死亡率（0.9%对0.5%对1.0%，P = 0.76）、心肌梗死（2%对1%对2%，P = 0.52）或MACE（3%对3%对4%，P = 0.57）方面无差异。住院期间出血情况也无差异（3%对2%对2%，P = 0.64）。
普拉格雷和替格瑞洛在接受PCI治疗的ACS患者中使用越来越多，主要用于合并症较少的年轻患者群体。尽管抗血小板治疗仍应根据血栓形成和出血风险进行个体化，但我们的研究强调了新型P2Y12抑制剂在当代澳大利亚临床实践中的安全性。
