title: Comparison of prasugrel and clopidogrel-treated patients with acute coronary syndrome undergoing percutaneous coronary intervention: A propensity score-matched analysis of the Acute Myocardial Infarction in Switzerland (AMIS)-Plus Registry.
abstract: OBJECTIVE
  The purpose of this study was to investigate outcomes of patients treated with prasugrel or clopidogrel after percutaneous coronary intervention (PCI) in a nationwide acute coronary syndrome (ACS) registry.
  
  
  BACKGROUND
  Prasugrel was found to be superior to clopidogrel in a randomized trial of ACS patients undergoing PCI. However, little is known about its efficacy in everyday practice.
  
  
  METHODS
  All ACS patients enrolled in the Acute Myocardial Infarction in Switzerland (AMIS)-Plus registry undergoing PCI and being treated with a thienopyridine P2Y12 inhibitor between January 2010-December 2013 were included in this analysis. Patients were stratified according to treatment with prasugrel or clopidogrel and outcomes were compared using propensity score matching. The primary endpoint was a composite of death, recurrent infarction and stroke at hospital discharge.
  
  
  RESULTS
  Out of 7621 patients, 2891 received prasugrel (38%) and 4730 received clopidogrel (62%). Independent predictors of in-hospital mortality were age, Killip class >2, STEMI, Charlson comorbidity index >1, and resuscitation prior to admission. After propensity score matching (2301 patients per group), the primary endpoint was significantly lower in prasugrel-treated patients (3.0% vs 4.3%; p=0.022) while bleeding events were more frequent (4.1% vs 3.0%; p=0.048). In-hospital mortality was significantly reduced (1.8% vs 3.1%; p=0.004), but no significant differences were observed in rates of recurrent infarction (0.8% vs 0.7%; p=1.00) or stroke (0.5% vs 0.6%; p=0.85). In a predefined subset of matched patients with one-year follow-up (n=1226), mortality between discharge and one year was not significantly reduced in prasugrel-treated patients (1.3% vs 1.9%, p=0.38).
  
  
  CONCLUSIONS
  In everyday practice in Switzerland, prasugrel is predominantly used in younger patients with STEMI undergoing primary PCI. A propensity score-matched analysis suggests a mortality benefit from prasugrel compared with clopidogrel in these patients.
authors.affiliation: Clinic for Cardiology, Triemli Hospital, Zurich, Switzerland david.kurz@triemli.zuerich.ch.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kurz
authors.affiliation: AMIS-Plus Data Center, University of Zurich, Switzerland.
authors.forename: Dragana
authors.initials: D
authors.lastname: Radovanovic
authors.affiliation: Division of Biostatistics, University of Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Clinic for Cardiology, Triemli Hospital, Zurich, Switzerland.
authors.forename: Alain M
authors.initials: AM
authors.lastname: Bernheim
authors.affiliation: Cardiology, University Hospital Geneva, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Roffi
authors.affiliation: Cardiocentro Ticino, Switzerland.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pedrazzini
authors.affiliation: Inselspital, Schweizer Herz- und Gefässzentrum, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Klinik St Anna, Lucerne, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
authors.affiliation: Clinic for Cardiology, Triemli Hospital, Zurich, Switzerland.
authors.forename: Franz R
authors.initials: FR
authors.lastname: Eberli
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D012042:Registries; D013557:Switzerland / Q000453:epidemiology; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine
keywords: Acute coronary syndrome; percutaneous coronary intervention; platelet aggregation inhibitors; propensity score; thienopyridines