title: Clopidogrel, prasugrel or ticagrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention.
abstract: BACKGROUND
  Guidelines recommend prasugrel or ticagrelor instead of clopidogrel in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary interventions (PCI).
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.|The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: M B
authors.initials: MB
authors.lastname: Yudi
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.|The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: D J
authors.initials: DJ
authors.lastname: Clark
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.|The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: O
authors.initials: O
authors.lastname: Farouque
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Eccleston
authors.affiliation: Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Andrianopoulos
authors.affiliation: Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.|Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Duffy
authors.affiliation: Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Brennan
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Lefkovits
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Ramchand
authors.affiliation: Department of Cardiology, Geelong University Hospital, Geelong, Victoria, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Yip
authors.affiliation: Department of Cardiology, Ballarat Base Hospital, Ballarat, Victoria, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Oqueli
authors.affiliation: Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.|School of Public Health, Curtin University, Perth, Western Australia, Australia.
authors.forename: C M
authors.initials: CM
authors.lastname: Reid
authors.affiliation: The University of Melbourne, Melbourne, Victoria, Australia.|Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.
authors.forename: A E
authors.initials: AE
authors.lastname: Ajani
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D000077144:Clopidogrel; D015897:Comorbidity; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000139:chemically induced; D062645:Percutaneous Coronary Intervention; D000068799:Prasugrel Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D012042:Registries; D000077486:Ticagrelor; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: acute coronary syndrome; antiplatelet agent; clopidogrel; prasugrel; ticagrelor