One-year clinical outcomes in patients with acute coronary syndrome treated with clopidogrel versus prasugrel versus ticagrelor: Results of the Polish Registry of Acute Coronary Syndromes (PL-ACS).

BACKGROUND: Efficient dual antiplatelet therapy is crucial in reducing adverse cardiovascular events in patients with acute coronary syndrome (ACS). Comparative effectiveness between clopidogrel, prasugrel, and ticagrelor remains unclear in real-world settings. AIMS: The objective was to evaluate one-year clinical outcomes in ACS patients treated with clopidogrel, prasugrel, or ticagrelor using data from the Polish Registry of Acute Coronary Syndromes (PL-ACS). MATERIAL AND METHODS: This retrospective cohort study analyzed 381 278 ACS patients from the PL-ACS registry from 2009 to 2022, who were treated with clopidogrel, prasugrel, or ticagrelor during hospitalization with a 12-month consistent regimen. The primary outcome was one-year all-cause mortality. Secondary outcomes included a composite of death, myocardial infarction, or stroke, and the net clinical outcome, a composite of all-cause death, myocardial infarction, stroke, and bleeding. Propensity score matching was applied to reduce confounding factors. Cox proportional hazards models were used for analysis. RESULTS: Of 381 278 ACS patients, 332 338 (87.2%) were treated with clopidogrel, 5312 (1.4%) with prasugrel, and 43 628 (11.4%) with ticagrelor. After propensity score matching, prasugrel and ticagrelor reduced mortality compared with clopidogrel (hazard ratios 1.69 and 1.72, respectively; P <0.0001). Ticagrelor also showed superior net clinical outcomes compared with both prasugrel and clopidogrel. CONCLUSIONS: This large-scale study confirms better clinical outcomes of dual antiplatelet therapy with prasugrel or ticagrelor compared to clopidogrel in ACS, with ticagrelor demonstrating superiority over prasugrel in terms of net clinical outcome. Despite the high clopidogrel usage rate in Poland, these findings support the preference for ticagrelor or prasugrel in ACS.

Duke Scholars

Author Paul Alfred Gurbel Medicine, Clinical Pharmacology