Safety and effectiveness of the new P2Y12r inhibitor agents vs clopidogrel in ACS patients according to the geographic area: East Asia vs Europe
Journal
International journal of Cardiology
Date Issued
2016-10-01
Author(s)
Giordana, Francesca
Montefusco, Antonio
D'Ascenzo, Fabrizio
Moretti, Claudio
Scarano, Silvia
Abu-Assi, Emad
Raposeiras-Roubín, Sergio
Henriques, Jose Paulo Simao
Saucedo, Jorge
González-Juanatey, José Ramón
Wilton, Stephen B
Kikkert, Wouter J
Nuñez-Gil, Iván
Ariza-Sole, Albert
Song, Xiantao
Alexopoulos, Dimitrios
Liebetrau, Christoph
Kawaji, Tetsuma
Huczek, Zenon
Nie, Shao-Ping
Fujii, Toshiharu
Correia, Luis
Kawashiri, Masa-Aki
García-Acuña, José María
Southern, Danielle
Alfonso, Emilio
Terol, Belén
Garay, Alberto
Zhang, Dongfeng
Chen, Yalei
Xanthopoulou, Ioanna
Osman, Neriman
Möllmann, Helge
Shiomi, Hiroki
Kowara, Michal
Filipiak, Krzysztof
Wang, Xiao
Yan, Yan
Fan, Jing-Yao
Ikari, Yuji
Nakahayshi, Takuya
Sakata, Kenji
Yamagishi, Masakazu
Gaita, F
DOI
10.1016/j.ijcard.2016.06.063
Abstract
Background
In the setting of the Acute Coronary Syndrome (ACS), differences in response to prasugrel and ticagrelor between East Asian and European patients have not been investigated yet.
Methods
This is a sub-analysis of the “BleeMACS registry”. Patients admitted for ACS and underwent PCI from between 2012 and 2014 were stratified first according to their provenance, Europe vs. East Asia (China and Japan), and then by country. The adjusted rate of 1-year serious bleeding -safety end-point- and 1-year death/re-infarction -effectiveness endpoint- of the new P2Y12r inhibitors were compared.
Results
Data of 10004 patients in Europe and 2332 patients in East Asia were collected. At baseline prior stroke (6% vs 9%, p<0.001, respectively) and type of ACS (59% vs 71% STEMI, 11% vs 21% Unstable Angina) were significantly different among the groups. At 1year follow-up no difference in bleeding (3% vs 3%, p=0.84) was found, while the between group incidence of death/re-infarction was significantly higher in the European centers (9% vs 5%, p<0.001). At the multivariate analysis, ticagrelor decreases the risk of MACE (Europe: HR 0.5, CI 0.3–0.9; East Asia: HR 0.5, CI 0.2–0.9), despite of a higher risk of bleeding in Caucasians (HR 1.7, CI 1.1–2.6). Prasugrel reduces death/re-infarction (HR 0.4, CI 0.2–0.6), without increasing bleeding (HR 0.9, CI 0.5–1.3).
Conclusions
In the setting of the ACS, the new anti-platelets drugs appear to be safe and efficacious at mid-term follow-up independently from the geographic area. Prasugrel seems to have the best risk–benefit, while ticagrelor appears safer in East Asians.
In the setting of the Acute Coronary Syndrome (ACS), differences in response to prasugrel and ticagrelor between East Asian and European patients have not been investigated yet.
Methods
This is a sub-analysis of the “BleeMACS registry”. Patients admitted for ACS and underwent PCI from between 2012 and 2014 were stratified first according to their provenance, Europe vs. East Asia (China and Japan), and then by country. The adjusted rate of 1-year serious bleeding -safety end-point- and 1-year death/re-infarction -effectiveness endpoint- of the new P2Y12r inhibitors were compared.
Results
Data of 10004 patients in Europe and 2332 patients in East Asia were collected. At baseline prior stroke (6% vs 9%, p<0.001, respectively) and type of ACS (59% vs 71% STEMI, 11% vs 21% Unstable Angina) were significantly different among the groups. At 1year follow-up no difference in bleeding (3% vs 3%, p=0.84) was found, while the between group incidence of death/re-infarction was significantly higher in the European centers (9% vs 5%, p<0.001). At the multivariate analysis, ticagrelor decreases the risk of MACE (Europe: HR 0.5, CI 0.3–0.9; East Asia: HR 0.5, CI 0.2–0.9), despite of a higher risk of bleeding in Caucasians (HR 1.7, CI 1.1–2.6). Prasugrel reduces death/re-infarction (HR 0.4, CI 0.2–0.6), without increasing bleeding (HR 0.9, CI 0.5–1.3).
Conclusions
In the setting of the ACS, the new anti-platelets drugs appear to be safe and efficacious at mid-term follow-up independently from the geographic area. Prasugrel seems to have the best risk–benefit, while ticagrelor appears safer in East Asians.