Effectiveness of new antiplatelets in the prevention of recurrent myocardial infarction

Lamiae Grimaldi-Bensouda (1) , Nicolas Danchin (2) , Jean Dallongeville (3) , Bruno Falissard (4) , Alain Furber (5, 6, 7) , Yves Cottin (8) , Laurent Bonello (9, 10, 11) , Olivier Morel (12, 13) , Florence Leclercq (14) , Etienne Puymirat (2) , Fahmi Ghanem (15) , Nicolas Delarche (16) , Jacques Bénichou (17, 18) , Lucien Abenhaim (1)

1 LSHTM - London School of Hygiene and Tropical Medicine
2 HEGP - Hôpital Européen Georges Pompidou [APHP]
3 RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167
4 CESP - Centre de recherche en épidémiologie et santé des populations
5 MITOVASC - MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale
6 CHU Angers - Centre Hospitalier Universitaire d'Angers
7 BNMI - Biologie Neurovasculaire et Mitochondriale Intégrée
8 Service de Cardiologie [CHU de Dijon]
9 CHU Marseille
10 AMU - Aix Marseille Université
11 APHM - Assistance Publique - Hôpitaux de Marseille
12 UNISTRA - Université de Strasbourg
13 Hémostase et biologie vasculaire
14 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
15 Centre Hospitalier de Châteauroux
16 Centre hospitalier de Pau
17 Unité de Biostatistiques [CHU Rouen]
18 BPH - Bordeaux population health

OBJECTIVE: To compare ticagrelor and prasugrel with clopidogrel for recurrent fatal and non-fatal myocardial infarction (reMI) in real-life conditions. METHODS: Case-referent study using the Pharmacoepidemiological General Research eXtension (PGRx)-acute coronary syndrome (ACS) registry. Cases were patients with reMI from a cohort with index ACS or external to the cohort (same sites). Referents from the cohort, without recurrent event, were matched on index ACS type and date, age and sex with reMI cases. Multivariate conditional logistic regression assessed the OR (95% CI) for reMI associated with ticagrelor and prasugrel vs clopidogrel, adjusted for aspirin use and cardiovascular risk factors. RESULTS: 1047 cases and 2234 matched referents were included. Compared with clopidogrel, ticagrelor and prasugrel were associated with respective ORs of 0.65 (95% CI 0.52 to 0.81) and 0.71 (95% CI 0.53 to 0.96) for reMI occurrence. ORs for ticagrelor and prasugrel vs clopidogrel were: 0.50 (95% CI 0.38 to 0.67) and 0.66 (95% CI 0.45 to 0.95), 0.39 (95% CI 0.24 to 0.62) and 0.44 (95% CI 0.26 to 0.75), 0.63 (95% CI 0.43 to 0.92) and 1.20 (95% CI 0.69 to 2.07), 1.11 (95% CI 0.72 to 1.72) and 0.82 (95% CI 0.44 to 1.54) when index ACS was a first MI, a first ST-elevated MI (STEMI), a first non-STEMI and a recurrent ACS, respectively, and 0.63 (95% CI 0.45 to 0.87) and 0.77 (95% CI 0.41 to 1.45) for patients aged ≥70  years. CONCLUSIONS: This real-world study showed a significant reduction of reMI with new antiplatelets compared with clopidogrel, ticagrelor being associated with a greater decrease of risk notably for first, either STEMI or non-STEMI. The larger magnitude of effect may be attributed to potential residual confounding or higher effectiveness compared with efficacy reported in trials (EMA Post Authorisation Study Registry Number EUPAS5905).

Domaines: Cardiologie et système cardiovasculaire

Lamiae Grimaldi-Bensouda, Nicolas Danchin, Jean Dallongeville, Bruno Falissard, Alain Furber, et al.. Effectiveness of new antiplatelets in the prevention of recurrent myocardial infarction. Heart, 2018, 104 (19), pp.1583-1592. ⟨10.1136/heartjnl-2017-312534⟩. ⟨hal-02341884⟩