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Acute coronary syndromes
HR 2.333; 95% CI 1.078–5.047). In addition, triple antithrombotic therapy was
not associated with a decreased risk of all-cause death or an increased risk of
bleeding.
P3700 | BEDSIDE
Intracoronary tenecteplase versus abciximab as adjunctive treatment
during primary PCI in acute myocardial infarction of anterior location
F.J. Morales Ponce 1 , F.J. Lozano Cid 1 , P. Martinez Romero 1 , P. Gonzalez Perez 1 ,
J.A. Sanchez Brotons 1 , I. Diaz Torres 1 , E. Martinez Morentin 1 , I. Perez Lopez 1 ,
F.J. Camacho Jurado 1 , R.F. Garcia Gonzalez 1 , P.L. Martinez Garcia 1 , C. Collado
Moreno 1 , S. Blasco Turrion 1 , P. Caro Mateo 2 , A. Serrador Frutos 3 . 1 Puerto Real
Hospital, Department of Cardiology- Puerto Real University Hospital, Puerto
Real, Spain; 2 DADISA Radiodiagnostico Medical Centre, Cadiz, Spain; 3 Institute
of Heart Sciences (ICICOR), Valladolid, Spain
Kaplan-Meier analysis of endpoints
Conclusions: In real-life patients with ACS following PCI and with an indication
of OAC, triple therapy was not associated with an increased rate of adverse outcomes compared to dual therapy. Moreover, it decreased risk of re-infarction and
did not increase risk of severe bleeding.
Acknowledgement/Funding: The National High Technology Research and Development Program (2015AA020102)
P3699 | BEDSIDE
Clopidogrel, prasugrel, or ticagrelor use and clinical outcome in
patients with acute coronary syndrome: a nationwide long-term
registry analysis from 2009 to 2014
S. Sheikh Rezaei 1 , A. Geroldinger 2 , G. Heinze 2 , B. Reichardt 3 , M. Wolzt 1 .
1
Medical University of Vienna, Department of Clinical Pharmacology, Vienna,
Austria; 2 Medical University of Vienna, Center for Medical Statistics, Information
and Intelligent Systems, Vienna, Austria; 3 Medical University of Vienna, Vienna,
Austria
Background: A dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA)
and P2Y12 inhibitors such as clopidogrel, prasugrel or ticagrelor is indicated for
patients after acute coronary syndrome (ACS). However, the decision on best use
of DAPT including treatment duration is under debate.
Purpose: The aim of this study was to investigate epidemiological data of longterm utilization and clinical outcome of clopidogrel, prasugrel and ticagrelor for
patients hospitalised with ACS between 2009 and 2014 in Austria.
Methods: Prescription and demographic data and information on hospital discharge diagnoses from 13 Austrian health insurance funds for the years 2009 to
2014 were analysed. The primary end point was recurrence of ACS or death >30
days after the index event.
Results: Out of 72676 patients with a hospital discharge diagnosis of ACS,
32830 subjects received a prescription with a P2Y12 inhibitor within 30 days after
the index event. 18640 (56.8%) subjects were discharged with clopidogrel, 6683
(20.4%) with prasugrel, and 7507 (22.9%) with ticagrelor, respectively. Data from
32174 patients with 4975 events during a median follow-up period of 24.9 months
were available for survival analysis. The cumulative incidence for recurrence of
ACS or death at two years was 18.7% in patients receiving clopidogrel, and 8.7%
and 12.0% in those receiving prasugrel or ticagrelor, respectively. The adjusted
hazard ratio for ACS was similar for ticagrelor vs clopidogrel (0.9 [95% CI 0.8;
1.0]) and lower for prasugrel vs clopidogrel (0.8 [95% CI 0.7; 0.9]). The adjusted
hazard ratio for death was lower for prasugrel or ticagrelor versus clopidogrel (0.6
[95% CI: 0.5; 0.7] and 0.7 [95% CI: 0.6; 0.8])
Conclusion: Clopidogrel, prasugrel, and ticagrelor utilization after ACS was consistent with guideline recommendations. The increasing prescription of prasugrel
and ticagrelor was associated with a lower number of recurrence of ACS or death
compared to clopidogrel. However, clopidogrel prescription was more frequent in
older patients with more comorbidities.
Background: Primary PCI is the preferred reperfusion strategy in patients with
STEMI, but controversy remains about the optimal adjunctive antithrombotic therapy and its route of administration. There are no randomised trials comparing intracoronary (IC) administration of fibrinolytic agents to that of GP IIb/IIIa inhibitors
during primary PCI. Our purpose was to compare the effects of IC administration
of tenecteplase to that of abciximab on myocardial perfusion and infarct size in
patients with acute STEMI of anterior location undergoing primary PCI.
Methods: We conducted a pilot study consisting in a phase-III, single-center,
prospective, randomised clinical trial. Seventy-six patients with acute anterior
STEMI were randomised to receive an IC infusion of reduced-dose tenecteplase
(one fifth part of systemic dose) or abciximab (standard dose) during primary PCI.
All patients were pretreated with heparin, aspirin and clopidogrel. Two days after
primary PCI, coronary angiography was repeated to obtain parameters of epicardial flow (corrected TIMI frame count) and myocardial perfusion (TIMI myocardial
perfusion grade- TMPG-, grades 0–3) for an ulterior blinded assessment at an
external independent core-lab. Major adverse cardiac events included cardiac
death, infarction, stroke and urgent target vessel revascularisation. A cardiacMRI was performed at 4 months at an external institution blinded to the treatment
groups in order to assess infarct size (the primary end-point of study) and LV
function.
Results: Two days after primary PCI, patients in the IC-abciximab group showed
a lower corrected TIMI frame count than patients in the IC-tenecteplase group
(median 14.1 versus 18.2, p=0.02), and the incidence of TMPG grade 2/3 was
higher in the IC-abciximab group than in the IC-tenecteplase group (90.3% versus
67.7%; p=0.03). The study was underpowered to detect substantial differences in
30-day major cardiac events (13.2% versus 5.3% in the IC-tenecteplase and ICabciximab groups, p=0.43) but, of note, 2 of 38 patients (5.3%) who had received
IC-tenecteplase experienced definite subacute stent thrombosis. Major bleeding
events were similar in both groups. At 4 months, patients in the IC-tenecteplase
group showed a small non-significant trend towards a lower infarct size than patients in the IC-abciximab group (mean 19.3 grams vs 23.3 grams, p=0.29, or
15.9% vs 17.7% of LV-mass respectively, p=0.51). Left-ventricular size or systolic
function on cardiac MRI did not significantly differ between study groups.
Conclusions: In our pilot trial, the administration of IC tenecteplase during primary PCI in anterior STEMI patients did not significantly reduce infarct size as
compared to IC abciximab. During the acute phase, IC abciximab showed to improve myocardial perfusion as compared to IC tenecteplase. It should also be
noted a higher than expected rate of definite subacute stent thrombosis in patients treated with IC tenecteplase.
Acknowledgement/Funding: This study was supported by a governmental grant
from the Spanish Ministry of Health and Social Policy
P3701 | BEDSIDE
Health implications of regional differences in the implementation of
new treatments for myocardial infarction: the case of ticagrelor in
Sweden
K.M. Johannesen 1 , M. Janzon 2 , T. Jernberg 3 , M. Henriksson 1 . 1 Linkoping
University, Department of medical and health sciences, Linkoping, Sweden;
2
Linkoping University, Department of Cardiology and Department of Medical and
Health Sciences, Linkoping, Sweden; 3 Karolinska Institute, Danderyd University
Hospital, Department of Clinical Sciences, Stockholm, Sweden
Background: The benefit of new treatments to patients is realized when they are
implemented in clinical practice. Suboptimal implementation may imply substantial health losses that are difficult to assess without nationwide follow-up data from
clinical practice.
Purpose: The aim of this study was to describe regional implementation and
its health consequences using ticagrelor treatment for patients with myocardial
infarction (MI) in Sweden as a case study.
Method: In a retrospective registry study, the number of patients age<80 years
with a MI and antiplatelet treatment was retrieved from the national quality register SWEDEHEART for 2011–2015. The register covers virtually all of the approximately 13,000 acute MIs occurring annually in patients <80 years in Sweden’s 10million population. The proportion of patients treated with ticagrelor per
year was estimated for each county council. Each year, we identified the county
council with the highest proportion of ticagrelor implementation. The number of
additional patients that would have been treated, if all county councils had implemented to this highest level, was calculated. The health implication of treating
these additional patients was estimated, in terms of MI, stroke, cardiovascular
death and life years, by applying ticagrelor effectiveness from the PLATelet inhibition and patient Outcomes trial (PLATO) and previously developed ticagrelor
long-term effectiveness models.
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