Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Eur Heart J. 2016 Nov 21;37(44):3335-3342. doi: 10.1093/eurheartj/ehw284. Epub 2016 Jul 19.
Ticagrelor reduces ischaemic events and mortality in acute coronary syndrome (ACS) vs. clopidogrel. We wished to study clinical outcomes in a large real-world population post-ACS.
We performed a prospective cohort study in 45 073 ACS patients enrolled into Swedish Web system for Enhancement and Development of Evidence-based care in Heart Disease Evaluated According to Recommended Therapies who were discharged on ticagrelor (N = 11 954) or clopidogrel (N = 33 119) between 1 January 2010 and 31 December 2013. The primary outcome was a composite of all-cause death, re-admission with myocardial infarction (MI) or stroke, secondary outcomes as the individual components of the primary outcome, and re-admission with bleeding. The risk of the primary outcome with ticagrelor vs. clopidogrel was 11.7 vs. 22.3% (adjusted hazard ratio (HR) 0.85 [95% confidence interval: 0.78-0.93]), risk of death 5.8 vs. 12.9% (adjusted HR 0.83 [0.75-0.92]), and risk of MI 6.1 vs. 10.8% (adjusted HR 0.89 [0.78-1.01]) at 24 months. Re-admission with bleeding with ticagrelor vs. clopidogrel occurred in 5.5 vs. 5.2% (adjusted HR 1.20 [1.04-1.40]). In a subset of patients undergoing percutaneous coronary intervention (PCI) on ticagrelor vs. clopidogrel the PCI-related in-hospital bleeding was 3.7 vs. 2.7% (adjusted odds ratio, OR, 1.57 [1.30-1.90]).
Ticagrelor vs. clopidogrel post-ACS was associated with a lower risk of death, MI, or stroke, as well as death alone. Risk of bleeding was higher with ticagrelor. These real-world outcomes are consistent with randomized trial results.
替格瑞洛可降低急性冠脉综合征（ACS）患者的缺血事件和死亡率，优于氯吡格雷。我们希望研究 ACS 后大型真实世界人群的临床结局。
我们对 2010 年 1 月 1 日至 2013 年 12 月 31 日期间在瑞典 Web 系统登记的接受替格瑞洛（n=11954）或氯吡格雷（n=33119）治疗并出院的 45073 例 ACS 患者进行了前瞻性队列研究。主要结局是全因死亡、因心肌梗死（MI）或卒中再次入院、次要结局为主要结局的各个组成部分，以及因出血再次入院。与氯吡格雷相比，替格瑞洛的主要结局风险为 11.7%比 22.3%（调整后危险比[HR]0.85[95%置信区间：0.78-0.93]），死亡风险为 5.8%比 12.9%（调整后 HR 0.83[0.75-0.92]），MI 风险为 6.1%比 10.8%（调整后 HR 0.89[0.78-1.01]），随访 24 个月。替格瑞洛与氯吡格雷相比，出血再次入院的风险为 5.5%比 5.2%（调整后 HR 1.20[1.04-1.40]）。在接受替格瑞洛行经皮冠状动脉介入治疗（PCI）的患者亚组中，PCI 相关院内出血为 3.7%比 2.7%（调整后比值比[OR]1.57[1.30-1.90]）。
ACS 后替格瑞洛与氯吡格雷相比，死亡、MI 或卒中风险以及单独死亡风险降低，出血风险增加。这些真实世界的结果与随机试验结果一致。
