Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark

Pernille Gro Thrane; Kevin Kris Warnakula Olesen; Morten Würtz; Christine Gyldenkerne; Morten Madsen; Lisette Okkels Jensen; Bent Raungaard; Henrik Toft Sørensen; Troels Thim; Steen Dalby Kristensen; Michael Maeng

doi:10.1016/j.lanepe.2021.100301

Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark

Pernille Gro Thrane^*, Kevin Kris Warnakula Olesen, Morten Würtz, Christine Gyldenkerne, Morten Madsen, Lisette Okkels Jensen, Bent Raungaard, Henrik Toft Sørensen, Troels Thim, Steen Dalby Kristensen, Michael Maeng

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Background: Ticagrelor was introduced in Denmark in 2011 after randomised data showed its superiority over clopidogrel for patients with acute coronary syndrome (ACS). We assessed the effectiveness and safety of ticagrelor implementation in ACS patients undergoing percutaneous coronary intervention (PCI).

Methods: We identified PCI-treated ACS patients in Western Denmark who redeemed a P2Y12 inhibitor prescription within 14 days. Using Danish health registries, 1-year outcomes were compared before (2007-2010) and after (2012-2015) introduction of ticagrelor. Outcomes were MACE (death, myocardial infarction, and ischaemic stroke) and hospitalisation for bleeding. Inverse probability of treatment weights were used to estimate weighted incidence rate ratios (wIRRs).

Findings: We included 14,450 patients; 7,102 were treated in the earlier time period (99·9% clopidogrel) and 7,348 in the later time period (87·8% ticagrelor). Ticagrelor implementation was not associated with a clinically relevant difference in 1-year risk of MACE with 413 events in the ticagrelor period vs. 424 events in the clopidogrel period (cumulative incidence percentage [CIP] 5·6% vs. 6·0%; wIRR 1·06, 95% CI 0·92-1·22). The 1-year risk of bleeding was also similar between groups with 335 bleedings requiring hospitalisation in the ticagrelor period vs. 309 events in the clopidogrel period (CIP 4·6% vs. 4·4%; wIRR 1·05, 95% CI 0·89-1·23). Results were robust in patients above and below 70 years of age.

Interpretation: Implementation of ticagrelor was not associated with changes in risks of ischaemic or bleeding events in Danish PCI-treated ACS patients.

Original language	English
Article number	100301
Journal	The Lancet Regional Health - Europe
Volume	14
ISSN	2666-7762
DOIs	https://doi.org/10.1016/j.lanepe.2021.100301
Publication status	Published - Mar 2022

Keywords

Antiplatelet therapy
Myocardial infarction
Percutaneous coronary intervention
Risk-benefit

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Thrane, P. G., Olesen, K. K. W., Würtz, M., Gyldenkerne, C., Madsen, M., Jensen, L. O., Raungaard, B., Sørensen, H. T., Thim, T., Kristensen, S. D., & Maeng, M. (2022). Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark. The Lancet Regional Health - Europe, 14, Article 100301. https://doi.org/10.1016/j.lanepe.2021.100301

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title = "Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark",

abstract = "Background: Ticagrelor was introduced in Denmark in 2011 after randomised data showed its superiority over clopidogrel for patients with acute coronary syndrome (ACS). We assessed the effectiveness and safety of ticagrelor implementation in ACS patients undergoing percutaneous coronary intervention (PCI).Methods: We identified PCI-treated ACS patients in Western Denmark who redeemed a P2Y12 inhibitor prescription within 14 days. Using Danish health registries, 1-year outcomes were compared before (2007-2010) and after (2012-2015) introduction of ticagrelor. Outcomes were MACE (death, myocardial infarction, and ischaemic stroke) and hospitalisation for bleeding. Inverse probability of treatment weights were used to estimate weighted incidence rate ratios (wIRRs).Findings: We included 14,450 patients; 7,102 were treated in the earlier time period (99·9% clopidogrel) and 7,348 in the later time period (87·8% ticagrelor). Ticagrelor implementation was not associated with a clinically relevant difference in 1-year risk of MACE with 413 events in the ticagrelor period vs. 424 events in the clopidogrel period (cumulative incidence percentage [CIP] 5·6% vs. 6·0%; wIRR 1·06, 95% CI 0·92-1·22). The 1-year risk of bleeding was also similar between groups with 335 bleedings requiring hospitalisation in the ticagrelor period vs. 309 events in the clopidogrel period (CIP 4·6% vs. 4·4%; wIRR 1·05, 95% CI 0·89-1·23). Results were robust in patients above and below 70 years of age.Interpretation: Implementation of ticagrelor was not associated with changes in risks of ischaemic or bleeding events in Danish PCI-treated ACS patients.",

keywords = "Antiplatelet therapy, Myocardial infarction, Percutaneous coronary intervention, Risk-benefit",

author = "Thrane, {Pernille Gro} and Olesen, {Kevin Kris Warnakula} and Morten W{\"u}rtz and Christine Gyldenkerne and Morten Madsen and Jensen, {Lisette Okkels} and Bent Raungaard and S{\o}rensen, {Henrik Toft} and Troels Thim and Kristensen, {Steen Dalby} and Michael Maeng",

note = "{\textcopyright} 2021 Published by Elsevier Ltd.",

year = "2022",

month = mar,

doi = "10.1016/j.lanepe.2021.100301",

language = "English",

volume = "14",

journal = "The Lancet Regional Health - Europe",

issn = "2666-7762",

publisher = "Elsevier",

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Thrane, PG , Olesen, KKW , Würtz, M , Gyldenkerne, C , Madsen, M, Jensen, LO, Raungaard, B, Sørensen, HT , Thim, T , Kristensen, SD & Maeng, M 2022, 'Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark', The Lancet Regional Health - Europe, vol. 14, 100301. https://doi.org/10.1016/j.lanepe.2021.100301

Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark. / Thrane, Pernille Gro ; Olesen, Kevin Kris Warnakula ; Würtz, Morten et al.
In: The Lancet Regional Health - Europe, Vol. 14, 100301, 03.2022.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention

T2 - A Cohort Study in Western Denmark

AU - Thrane, Pernille Gro

AU - Olesen, Kevin Kris Warnakula

AU - Würtz, Morten

AU - Gyldenkerne, Christine

AU - Madsen, Morten

AU - Jensen, Lisette Okkels

AU - Raungaard, Bent

AU - Sørensen, Henrik Toft

AU - Thim, Troels

AU - Kristensen, Steen Dalby

AU - Maeng, Michael

PY - 2022/3

Y1 - 2022/3

N2 - Background: Ticagrelor was introduced in Denmark in 2011 after randomised data showed its superiority over clopidogrel for patients with acute coronary syndrome (ACS). We assessed the effectiveness and safety of ticagrelor implementation in ACS patients undergoing percutaneous coronary intervention (PCI).Methods: We identified PCI-treated ACS patients in Western Denmark who redeemed a P2Y12 inhibitor prescription within 14 days. Using Danish health registries, 1-year outcomes were compared before (2007-2010) and after (2012-2015) introduction of ticagrelor. Outcomes were MACE (death, myocardial infarction, and ischaemic stroke) and hospitalisation for bleeding. Inverse probability of treatment weights were used to estimate weighted incidence rate ratios (wIRRs).Findings: We included 14,450 patients; 7,102 were treated in the earlier time period (99·9% clopidogrel) and 7,348 in the later time period (87·8% ticagrelor). Ticagrelor implementation was not associated with a clinically relevant difference in 1-year risk of MACE with 413 events in the ticagrelor period vs. 424 events in the clopidogrel period (cumulative incidence percentage [CIP] 5·6% vs. 6·0%; wIRR 1·06, 95% CI 0·92-1·22). The 1-year risk of bleeding was also similar between groups with 335 bleedings requiring hospitalisation in the ticagrelor period vs. 309 events in the clopidogrel period (CIP 4·6% vs. 4·4%; wIRR 1·05, 95% CI 0·89-1·23). Results were robust in patients above and below 70 years of age.Interpretation: Implementation of ticagrelor was not associated with changes in risks of ischaemic or bleeding events in Danish PCI-treated ACS patients.

AB - Background: Ticagrelor was introduced in Denmark in 2011 after randomised data showed its superiority over clopidogrel for patients with acute coronary syndrome (ACS). We assessed the effectiveness and safety of ticagrelor implementation in ACS patients undergoing percutaneous coronary intervention (PCI).Methods: We identified PCI-treated ACS patients in Western Denmark who redeemed a P2Y12 inhibitor prescription within 14 days. Using Danish health registries, 1-year outcomes were compared before (2007-2010) and after (2012-2015) introduction of ticagrelor. Outcomes were MACE (death, myocardial infarction, and ischaemic stroke) and hospitalisation for bleeding. Inverse probability of treatment weights were used to estimate weighted incidence rate ratios (wIRRs).Findings: We included 14,450 patients; 7,102 were treated in the earlier time period (99·9% clopidogrel) and 7,348 in the later time period (87·8% ticagrelor). Ticagrelor implementation was not associated with a clinically relevant difference in 1-year risk of MACE with 413 events in the ticagrelor period vs. 424 events in the clopidogrel period (cumulative incidence percentage [CIP] 5·6% vs. 6·0%; wIRR 1·06, 95% CI 0·92-1·22). The 1-year risk of bleeding was also similar between groups with 335 bleedings requiring hospitalisation in the ticagrelor period vs. 309 events in the clopidogrel period (CIP 4·6% vs. 4·4%; wIRR 1·05, 95% CI 0·89-1·23). Results were robust in patients above and below 70 years of age.Interpretation: Implementation of ticagrelor was not associated with changes in risks of ischaemic or bleeding events in Danish PCI-treated ACS patients.

KW - Antiplatelet therapy

KW - Myocardial infarction

KW - Percutaneous coronary intervention

KW - Risk-benefit

U2 - 10.1016/j.lanepe.2021.100301

DO - 10.1016/j.lanepe.2021.100301

M3 - Journal article

C2 - 35146473

SN - 2666-7762

VL - 14

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 100301

ER -

Effectiveness and Safety of Ticagrelor Implementation in Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention: A Cohort Study in Western Denmark

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Keywords

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