Clopidogrel vs. prasugrel vs. ticagrelor in patients with acute myocardial infarction complicated by cardiogenic shock: a pooled IABP-SHOCK II and CULPRIT-SHOCK trial sub-analysis
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Clopidogrel vs. prasugrel vs. ticagrelor in patients with acute myocardial infarction complicated by cardiogenic shock: a pooled IABP-SHOCK II and CULPRIT-SHOCK trial sub-analysis. / Orban, Martin; Kleeberger, Jan; Ouarrak, Taoufik; Freund, Anne; Feistritzer, Hans-Josef; Fuernau, Georg; Geisler, Tobias; Huber, Kurt; Dudek, Dariusz; Noc, Marko; Montalescot, Gilles; Neumer, Alexander; Haller, Paul; Clemmensen, Peter; Zeymer, Uwe; Desch, Steffen; Massberg, Steffen; Schneider, Steffen; Thiele, Holger; Hausleiter, Jörg.
in: CLIN RES CARDIOL, Jahrgang 110, Nr. 9, 09.2021, S. 1493-1503.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Clopidogrel vs. prasugrel vs. ticagrelor in patients with acute myocardial infarction complicated by cardiogenic shock: a pooled IABP-SHOCK II and CULPRIT-SHOCK trial sub-analysis
AU - Orban, Martin
AU - Kleeberger, Jan
AU - Ouarrak, Taoufik
AU - Freund, Anne
AU - Feistritzer, Hans-Josef
AU - Fuernau, Georg
AU - Geisler, Tobias
AU - Huber, Kurt
AU - Dudek, Dariusz
AU - Noc, Marko
AU - Montalescot, Gilles
AU - Neumer, Alexander
AU - Haller, Paul
AU - Clemmensen, Peter
AU - Zeymer, Uwe
AU - Desch, Steffen
AU - Massberg, Steffen
AU - Schneider, Steffen
AU - Thiele, Holger
AU - Hausleiter, Jörg
N1 - © 2021. The Author(s).
PY - 2021/9
Y1 - 2021/9
N2 - AIMS: The aim of this pooled sub-analysis of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) and Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) trial was to compare the clinical outcome of patients with acute myocardial infarction complicated by cardiogenic shock treated either with clopidogrel or the newer, more potent ADP-receptor antagonists prasugrel or ticagrelor.METHODS AND RESULTS: For the current analysis the primary endpoint was 1-year mortality and the secondary safety endpoint was moderate or severe bleedings until hospital discharge with respect to three different ADP-receptor antagonists. 856 patients were eligible for analysis. Of these, 507 patients (59.2%) received clopidogrel, 178 patients (20.8%) prasugrel and 171 patients (20.0%) ticagrelor as acute antiplatelet therapy. The adjusted rate of mortality after 1-year did not differ significantly between prasugrel and clopidogrel (hazard ratio [HR]: 0.81, 95% confidence interval [CI] 0.60-1.09, padj = 0.17) or between ticagrelor and clopidogrel treated patients (HR: 0.86, 95% CI 0.65-1.15, padj = 0.31). In-hospital bleeding events were significantly less frequent in patients treated with ticagrelor vs. clopidogrel (HR: 0.37, 95% CI 0.20 -0.69, padj = 0.002) and not significantly different in patients treated with prasugrel vs. clopidogrel (HR: 0.73, 95% CI 0.43 -1.24, padj = 0.24).CONCLUSION: This pooled sub-analysis is the largest analysis on safety and efficacy of three oral ADP-receptor antagonists and shows that acute therapy with either clopidogrel, prasugrel or ticagrelor is no independent predictor of 1-year mortality. Treatment with ticagrelor seems independently associated with less in-hospital moderate and severe bleeding events compared to clopidogrel. This finding might be due to selection bias and should be interpreted with caution.
AB - AIMS: The aim of this pooled sub-analysis of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) and Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) trial was to compare the clinical outcome of patients with acute myocardial infarction complicated by cardiogenic shock treated either with clopidogrel or the newer, more potent ADP-receptor antagonists prasugrel or ticagrelor.METHODS AND RESULTS: For the current analysis the primary endpoint was 1-year mortality and the secondary safety endpoint was moderate or severe bleedings until hospital discharge with respect to three different ADP-receptor antagonists. 856 patients were eligible for analysis. Of these, 507 patients (59.2%) received clopidogrel, 178 patients (20.8%) prasugrel and 171 patients (20.0%) ticagrelor as acute antiplatelet therapy. The adjusted rate of mortality after 1-year did not differ significantly between prasugrel and clopidogrel (hazard ratio [HR]: 0.81, 95% confidence interval [CI] 0.60-1.09, padj = 0.17) or between ticagrelor and clopidogrel treated patients (HR: 0.86, 95% CI 0.65-1.15, padj = 0.31). In-hospital bleeding events were significantly less frequent in patients treated with ticagrelor vs. clopidogrel (HR: 0.37, 95% CI 0.20 -0.69, padj = 0.002) and not significantly different in patients treated with prasugrel vs. clopidogrel (HR: 0.73, 95% CI 0.43 -1.24, padj = 0.24).CONCLUSION: This pooled sub-analysis is the largest analysis on safety and efficacy of three oral ADP-receptor antagonists and shows that acute therapy with either clopidogrel, prasugrel or ticagrelor is no independent predictor of 1-year mortality. Treatment with ticagrelor seems independently associated with less in-hospital moderate and severe bleeding events compared to clopidogrel. This finding might be due to selection bias and should be interpreted with caution.
KW - Aged
KW - Aged, 80 and over
KW - Clopidogrel/administration & dosage
KW - Female
KW - Follow-Up Studies
KW - Hemorrhage/chemically induced
KW - Humans
KW - Intra-Aortic Balloon Pumping/methods
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/complications
KW - Percutaneous Coronary Intervention
KW - Platelet Aggregation Inhibitors/administration & dosage
KW - Prasugrel Hydrochloride/administration & dosage
KW - Prospective Studies
KW - Shock, Cardiogenic/mortality
KW - Ticagrelor/administration & dosage
U2 - 10.1007/s00392-021-01866-3
DO - 10.1007/s00392-021-01866-3
M3 - SCORING: Journal article
C2 - 33999281
VL - 110
SP - 1493
EP - 1503
JO - CLIN RES CARDIOL
JF - CLIN RES CARDIOL
SN - 1861-0684
IS - 9
ER -