Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
Eur Heart J Acute Cardiovasc Care. 2022 Sep 29;11(9):697-705. doi: 10.1093/ehjacc/zuac095.
To compare the effectiveness and safety of clopidogrel, ticagrelor, and prasugrel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).
Nationwide, registry-based study of STEMI patients treated with primary PCI (2011-17) and subsequently with aspirin and a P2Y12 inhibitor. The effectiveness outcome was major adverse cardiovascular events (MACE) defined as a composite of recurrent myocardial infarction, repeat revascularization, stroke, or cardiovascular death at 12 months. The safety outcome was bleeding requiring hospitalization at 12 months. Multivariable logistic regression with average treatment effect modeling was used to calculate absolute and relative risks for outcomes standardized to the distributions of demographic characteristics of all included subjects. We included 10 832 patients; 1 697 were treated with clopidogrel, 7 508 with ticagrelor, and 1,627 with prasugrel. Median ages were 66, 63, and 59 years (P < 0.001). Standardized relative risks of MACE were 0.75 for ticagrelor vs. clopidogrel (95% confidence interval [CI], 0.64-0.83), 0.84 for prasugrel vs. clopidogrel (95% CI, 0.73-0.94), and 1.12 for prasugrel vs. ticagrelor (95% CI, 1.00-1.24). Standardized relative risks of bleeding were 0.77 for ticagrelor vs. clopidogrel (95% CI, 0.59-0.93), 0.89 for prasugrel vs. clopidogrel (95% CI, 0.64-1.15), and 1.17 for prasugrel vs. ticagrelor (95% CI, 0.89-1.45).
Ticagrelor and prasugrel were associated with lower risks of MACE after STEMI than clopidogrel, and ticagrelor was associated with a marginal reduction compared with prasugrel. The risk of bleeding was lower with ticagrelor compared with clopidogrel, but did not significantly differ between ticagrelor and prasugrel.
比较替格瑞洛、氯吡格雷和普拉格雷在接受经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中的疗效和安全性。
本研究为全国性、基于注册的 STEMI 患者研究，这些患者接受了直接 PCI（2011-2017 年）治疗，随后接受了阿司匹林和 P2Y12 抑制剂治疗。有效性结局为主要不良心血管事件（MACE），定义为 12 个月时复发性心肌梗死、再次血运重建、卒中和心血管死亡的复合事件。安全性结局为需要住院治疗的出血。使用平均治疗效果模型的多变量逻辑回归计算了所有纳入患者的人口统计学特征分布标准化后的结局的绝对和相对风险。我们纳入了 10832 例患者；其中 1697 例接受氯吡格雷治疗，7508 例接受替格瑞洛治疗，1627 例接受普拉格雷治疗。中位年龄分别为 66、63 和 59 岁（P<0.001）。替格瑞洛与氯吡格雷相比，MACE 的标准化相对风险为 0.75（95%置信区间[CI]，0.64-0.83），普拉格雷与氯吡格雷相比为 0.84（95%CI，0.73-0.94），普拉格雷与替格瑞洛相比为 1.12（95%CI，1.00-1.24）。替格瑞洛与氯吡格雷相比，出血的标准化相对风险为 0.77（95%CI，0.59-0.93），普拉格雷与氯吡格雷相比为 0.89（95%CI，0.64-1.15），普拉格雷与替格瑞洛相比为 1.17（95%CI，0.89-1.45）。
与氯吡格雷相比，替格瑞洛和普拉格雷在 STEMI 后发生 MACE 的风险较低，替格瑞洛与普拉格雷相比，MACE 风险略有降低。与氯吡格雷相比，替格瑞洛的出血风险较低，但与普拉格雷相比，出血风险无显著差异。
