2015年至2017年奥地利急性冠状动脉综合征患者使用氯吡格雷、普拉格雷或替格瑞洛与患者预后的关系
Use of Clopidogrel, Prasugrel, or Ticagrelor and Patient Outcome after Acute Coronary Syndrome in Austria from 2015 to 2017.
作者信息
Sheikh Rezaei Safoura, Gleiss Andreas, Reichardt Berthold, Wolzt Michael
机构信息
Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
出版信息
J Clin Med. 2020 Oct 23;9(11):3398. doi: 10.3390/jcm9113398.
BACKGROUND
Dual antiplatelet therapy improves patient outcome after acute coronary syndrome (ACS), but prescription differences of P2Y12 inhibitor treatments exist. The aim of the present investigation was to study the long-term utilization and patient outcomes of clopidogrel, prasugrel, and ticagrelor in patients with ACS from 2015 to 2017 in Austria.
METHODS
Data from 13 Austrian health insurance funds of patients with a hospital discharge diagnosis of ACS for the years 2015 to 2017 were analyzed. The primary end point was to investigate the recurrence of ACS or death.
RESULTS
Of 49,124 P2Y12 inhibitor-naive patients with a hospital discharge diagnosis of ACS, 25,147 subjects filled a P2Y12 inhibitor prescription within 30 days after the index event. Of these patients, 10,626 (42.9%) subjects had a prescription for clopidogrel, 4788 (19.3%) for prasugrel, and 9383 (37.8%) for ticagrelor. Ticagrelor was the most frequently prescribed P2Y12 inhibitor among patients below 70 years old, and clopidogrel in those aged ≥70 years. Occurrence of an endpoint was highest in elderly patients. After adjustment for age, sex, and pre-existing medication as proxy for comorbidity, the hazard ratio for ACS or death for prasugrel vs. clopidogrel of 0.70 (95% CI: 0.61; 0.79) was similar to that of ticagrelor vs. clopidogrel (0.70; 95% CI: 0.64; 0.77).
CONCLUSION
Prescription of ticagrelor or prasugrel after ACS were associated with a lower risk of ACS recurrence or death compared to clopidogrel.
背景
双联抗血小板治疗可改善急性冠状动脉综合征（ACS）患者的预后，但P2Y12抑制剂治疗的处方存在差异。本研究的目的是探讨2015年至2017年奥地利ACS患者中氯吡格雷、普拉格雷和替格瑞洛的长期使用情况及患者预后。
方法
分析了奥地利13家医疗保险基金中2015年至2017年出院诊断为ACS患者的数据。主要终点是调查ACS复发或死亡情况。
结果
在49124例初次使用P2Y12抑制剂且出院诊断为ACS的患者中，25147例患者在索引事件后30天内开具了P2Y12抑制剂处方。在这些患者中，10626例（42.9%）开具了氯吡格雷处方，4788例（19.3%）开具了普拉格雷处方，9383例（37.8%）开具了替格瑞洛处方。替格瑞洛是70岁以下患者中最常开具的P2Y12抑制剂，而氯吡格雷则是70岁及以上患者中最常开具的。终点事件的发生率在老年患者中最高。在对年龄、性别和作为合并症替代指标的既往用药进行调整后，普拉格雷与氯吡格雷相比，ACS或死亡的风险比为0.70（95%CI：0.61；0.79），与替格瑞洛与氯吡格雷相比（0.70；95%CI：0.64；0.77）相似。
结论
与氯吡格雷相比，ACS后开具替格瑞洛或普拉格雷处方与较低的ACS复发或死亡风险相关。
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