title: Ticagrelor versus clopidogrel in real-world patients with ST elevation myocardial infarction: 1-year results by propensity score analysis.
abstract: European guidelines recommend the use of ticagrelor versus clopidogrel in patients with ST elevation myocardial infarction (STEMI). This recommendation is based on inconclusive results and subanalyses from clinical trials. Few data are available on the effects of ticagrelor in a real-world population.
  
  
  
  To compare the effects of ticagrelor and clopidogrel in a real-world STEMI population, we conducted a pre-post case-control study examining all patients with STEMI included in the Cardio-STEMI Sanremo registry between February 2011 and June 2013. Cases and controls were defined according to P2Y12inhibitors, correcting the bias due to lack of randomization by propensity score analysis. Ticagrelor was introduced in 2012 in both in-hospital and pre-hospital settings independently of this study.
  
  
  
  Of the 416 patients enrolled in the Cardio-STEMI registry, 401 with a definite diagnosis of STEMI were included in this study. One hundred forty-two patients received ticagrelor and 259 received clopidogrel. Regarding clinical presentation and procedural data, those in the ticagrelor group had lower CRUSADE scores (23 [14-36] vs 27 [18-38]; p = 0.015] but a higher proportion of radial access (33% vs 14%; p < 0.001), percutaneous coronary intervention (PCI; 92% vs 81 %; p = 0.002) and primary PCI ≤ 12 h (82% vs 66%; p = 0.001). The patients in the ticagrelor group had a higher procedural success rate (100% vs. 96%; p = 0.044). There was no difference in Bleeding Academic Research Consortium bleeding and in unadjusted incidence of hospital major adverse cardiovascular events (MACE; cardiac death, myocardial infarction, or stroke) but there was a significant reduction in unadjusted cardiac hospital death in the ticagrelor group (0.7% vs 5.4%; p = 0.024). After correcting for propensity score, hospital death (p = 0.22) and hospital MACE (p = 0.96) did not differ in both groups. The unadjusted survival at 1 year after STEMI was higher in the ticagrelor group (97.8% vs 87.8%; p = 0.024), and this result was confirmed by propensity score analysis (hazard ratio = 0.29 [0.08-0.99]; p = 0.048).
  
  
  
  In this real-word propensity score analysis, ticagrelor did not affect the risk of MACE during the hospital phase, or the incidence of hospital bleeding in patients with STEMI. However, in this mono-centric experience, ticagrelor resulted in improved 1-year survival, even after correction by propensity score.
authors.affiliation: Interventional Cardiology, Santi Antonio, Biagio e Cesare Arrigo Hospital, Alessandria, AL, Italy. matteovrc@gmail.com.
authors.forename: Matteo
authors.identifier: 0000-0003-0021-9523
authors.initials: M
authors.lastname: Vercellino
authors.affiliation: Coronary Care Unit, Sanremo Hospital, Sanremo, IM, Italy.
authors.forename: Federico Ariel
authors.initials: FA
authors.lastname: Sànchez
authors.affiliation: Interventional Cardiology, Sanremo Hospital, Sanremo, IM, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Boasi
authors.affiliation: Sanremo Hospital, Sanremo, IM, Italy.
authors.forename: Dino
authors.initials: D
authors.lastname: Perri
authors.affiliation: Emergency Room, Sanremo Hospital, Sanremo, IM, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Tacchi
authors.affiliation: Interventional Cardiology, Santi Antonio, Biagio e Cesare Arrigo Hospital, Alessandria, AL, Italy.
authors.forename: Gioel Gabrio
authors.initials: GG
authors.lastname: Secco
authors.affiliation: Sanremo Hospital, Sanremo, IM, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cattunar
authors.affiliation: Cardiology Unit, Santi Antonio, Biagio e Cesare Arrigo Hospital, Alessandria, AL, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Pistis
authors.affiliation: Cardiology Unit, Sanremo Hospital, Sanremo, IM, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mascelli
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000368:Aged; D000077144:Clopidogrel; D017023:Coronary Angiography; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D057216:Propensity Score; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage; D012042:Registries; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: Acute coronary syndrome; Clopidogrel; Registry; ST elevation myocardial infarction; Ticagrelor