Early clinical outcomes as a function of use of newer oral P2Y inhibitors versus clopidogrel in the EUROMAX trial

Kurt Huber; Gregory Ducrocq; Christian W Hamm; Arnoud van 't Hof; Frédéric Lapostolle; Pierre Coste; Giovanni Gordini; Jacob Steinmetz; Freek W A Verheugt; Jennifer Adgey; Lutz Nibbe; Vojko Kaniĉ; Peter Clemmensen; Uwe Zeymer; Debra Bernstein; Jayne Prats; Efthymios N Deliargyris; Ph Gabriel Steg

doi:10.1136/openhrt-2017-000677

Early clinical outcomes as a function of use of newer oral P2Y inhibitors versus clopidogrel in the EUROMAX trial

Kurt Huber, Gregory Ducrocq, Christian W Hamm, Arnoud van 't Hof, Frédéric Lapostolle, Pierre Coste, Giovanni Gordini, Jacob Steinmetz, Freek W A Verheugt, Jennifer Adgey, Lutz Nibbe, Vojko Kaniĉ, Peter Clemmensen, Uwe Zeymer, Debra Bernstein, Jayne Prats, Efthymios N Deliargyris, Ph Gabriel Steg

Institut for Klinisk Medicin

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Abstract

Objective: To ascertain whether different oral P2Y12 inhibitors might affect rates of acute stent thrombosis and 30-day outcomes after primary percutaneous coronary intervention (pPCI).

Methods: The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) randomised trial compared prehospital bivalirudin with heparin with optional glycoprotein IIb/IIIa inhibitor treatment in patients with ST-segment elevation myocardial infarction triaged to pPCI. Choice of P2Y12 inhibitor was at the investigator's discretion. In a prespecified analysis, we compared event rates with clopidogrel and newer oral P2Y12 inhibitors (prasugrel, ticagrelor). Rates of the primary outcome (acute stent thrombosis) were examined as a function of the P2Y12 inhibitor used for loading and 30-day outcomes (including major adverse cardiac events) as a function of the P2Y12 inhibitor used for maintenance therapy. Logistic regression was used to adjust for differences in baseline characteristics.

Results: Prasugrel or ticagrelor was given as the loading P2Y12 inhibitor in 49% of 2198 patients and as a maintenance therapy in 59%. No differences were observed in rates of acute stent thrombosis for clopidogrel versus newer P2Y12 inhibitors (adjusted OR 0.50, 95% CI 0.13 to 1.85). After adjustment, no difference was observed in 30-day outcomes according to maintenance therapy except for protocol major (p=0.029) or minor (p=0.025) bleeding and Thrombolysis In Myocardial Infarction minor bleeding (p=0.002), which were less frequent in patients on clopidogrel. Consistent results were observed in the bivalirudin and heparin arms.

Conclusions: The choice of prasugrel or ticagrelor over clopidogrel was not associated with differences in acute stent thrombosis or 30-day ischaemic outcomes after pPCI.

Trial registration number: NCT01087723.

Originalsprog	Engelsk
Artikelnummer	e000677
Tidsskrift	Open Heart
Vol/bind	4
Udgave nummer	2
Antal sider	8
ISSN	2398-595X
DOI	https://doi.org/10.1136/openhrt-2017-000677
Status	Udgivet - 2017

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10.1136/openhrt-2017-000677Licens: CC BY-NC

Early clinical outcomes as a function of use of newer oral P2Y12 inhibitors versus clopidogrel in the EUROMAX trialForlagets udgivne version, 556 KBLicens: CC BY-NC

Citationsformater

Huber, K., Ducrocq, G., Hamm, C. W., van 't Hof, A., Lapostolle, F., Coste, P., Gordini, G., Steinmetz, J., Verheugt, F. W. A., Adgey, J., Nibbe, L., Kaniĉ, V., Clemmensen, P., Zeymer, U., Bernstein, D., Prats, J., Deliargyris, E. N., & Gabriel Steg, P. (2017). Early clinical outcomes as a function of use of newer oral P2Y inhibitors versus clopidogrel in the EUROMAX trial. Open Heart, 4(2), [e000677]. https://doi.org/10.1136/openhrt-2017-000677

Huber, K, Ducrocq, G, Hamm, CW, van 't Hof, A, Lapostolle, F, Coste, P, Gordini, G, Steinmetz, J, Verheugt, FWA, Adgey, J, Nibbe, L, Kaniĉ, V, Clemmensen, P, Zeymer, U, Bernstein, D, Prats, J, Deliargyris, EN & Gabriel Steg, P 2017, 'Early clinical outcomes as a function of use of newer oral P2Y inhibitors versus clopidogrel in the EUROMAX trial', Open Heart, bind 4, nr. 2, e000677. https://doi.org/10.1136/openhrt-2017-000677

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title = "Early clinical outcomes as a function of use of newer oral P2Y inhibitors versus clopidogrel in the EUROMAX trial",

abstract = "Objective: To ascertain whether different oral P2Y12 inhibitors might affect rates of acute stent thrombosis and 30-day outcomes after primary percutaneous coronary intervention (pPCI).Methods: The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) randomised trial compared prehospital bivalirudin with heparin with optional glycoprotein IIb/IIIa inhibitor treatment in patients with ST-segment elevation myocardial infarction triaged to pPCI. Choice of P2Y12 inhibitor was at the investigator's discretion. In a prespecified analysis, we compared event rates with clopidogrel and newer oral P2Y12 inhibitors (prasugrel, ticagrelor). Rates of the primary outcome (acute stent thrombosis) were examined as a function of the P2Y12 inhibitor used for loading and 30-day outcomes (including major adverse cardiac events) as a function of the P2Y12 inhibitor used for maintenance therapy. Logistic regression was used to adjust for differences in baseline characteristics.Results: Prasugrel or ticagrelor was given as the loading P2Y12 inhibitor in 49% of 2198 patients and as a maintenance therapy in 59%. No differences were observed in rates of acute stent thrombosis for clopidogrel versus newer P2Y12 inhibitors (adjusted OR 0.50, 95% CI 0.13 to 1.85). After adjustment, no difference was observed in 30-day outcomes according to maintenance therapy except for protocol major (p=0.029) or minor (p=0.025) bleeding and Thrombolysis In Myocardial Infarction minor bleeding (p=0.002), which were less frequent in patients on clopidogrel. Consistent results were observed in the bivalirudin and heparin arms.Conclusions: The choice of prasugrel or ticagrelor over clopidogrel was not associated with differences in acute stent thrombosis or 30-day ischaemic outcomes after pPCI.Trial registration number: NCT01087723.",

author = "Kurt Huber and Gregory Ducrocq and Hamm, {Christian W} and {van 't Hof}, Arnoud and Fr{\'e}d{\'e}ric Lapostolle and Pierre Coste and Giovanni Gordini and Jacob Steinmetz and Verheugt, {Freek W A} and Jennifer Adgey and Lutz Nibbe and Vojko Kaniĉ and Peter Clemmensen and Uwe Zeymer and Debra Bernstein and Jayne Prats and Deliargyris, {Efthymios N} and {Gabriel Steg}, Ph",

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doi = "10.1136/openhrt-2017-000677",

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journal = "Open Heart",

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TY - JOUR

T1 - Early clinical outcomes as a function of use of newer oral P2Y inhibitors versus clopidogrel in the EUROMAX trial

AU - Huber, Kurt

AU - Ducrocq, Gregory

AU - Hamm, Christian W

AU - van 't Hof, Arnoud

AU - Lapostolle, Frédéric

AU - Coste, Pierre

AU - Gordini, Giovanni

AU - Steinmetz, Jacob

AU - Verheugt, Freek W A

AU - Adgey, Jennifer

AU - Nibbe, Lutz

AU - Kaniĉ, Vojko

AU - Clemmensen, Peter

AU - Zeymer, Uwe

AU - Bernstein, Debra

AU - Prats, Jayne

AU - Deliargyris, Efthymios N

AU - Gabriel Steg, Ph

PY - 2017

Y1 - 2017

N2 - Objective: To ascertain whether different oral P2Y12 inhibitors might affect rates of acute stent thrombosis and 30-day outcomes after primary percutaneous coronary intervention (pPCI).Methods: The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) randomised trial compared prehospital bivalirudin with heparin with optional glycoprotein IIb/IIIa inhibitor treatment in patients with ST-segment elevation myocardial infarction triaged to pPCI. Choice of P2Y12 inhibitor was at the investigator's discretion. In a prespecified analysis, we compared event rates with clopidogrel and newer oral P2Y12 inhibitors (prasugrel, ticagrelor). Rates of the primary outcome (acute stent thrombosis) were examined as a function of the P2Y12 inhibitor used for loading and 30-day outcomes (including major adverse cardiac events) as a function of the P2Y12 inhibitor used for maintenance therapy. Logistic regression was used to adjust for differences in baseline characteristics.Results: Prasugrel or ticagrelor was given as the loading P2Y12 inhibitor in 49% of 2198 patients and as a maintenance therapy in 59%. No differences were observed in rates of acute stent thrombosis for clopidogrel versus newer P2Y12 inhibitors (adjusted OR 0.50, 95% CI 0.13 to 1.85). After adjustment, no difference was observed in 30-day outcomes according to maintenance therapy except for protocol major (p=0.029) or minor (p=0.025) bleeding and Thrombolysis In Myocardial Infarction minor bleeding (p=0.002), which were less frequent in patients on clopidogrel. Consistent results were observed in the bivalirudin and heparin arms.Conclusions: The choice of prasugrel or ticagrelor over clopidogrel was not associated with differences in acute stent thrombosis or 30-day ischaemic outcomes after pPCI.Trial registration number: NCT01087723.

AB - Objective: To ascertain whether different oral P2Y12 inhibitors might affect rates of acute stent thrombosis and 30-day outcomes after primary percutaneous coronary intervention (pPCI).Methods: The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) randomised trial compared prehospital bivalirudin with heparin with optional glycoprotein IIb/IIIa inhibitor treatment in patients with ST-segment elevation myocardial infarction triaged to pPCI. Choice of P2Y12 inhibitor was at the investigator's discretion. In a prespecified analysis, we compared event rates with clopidogrel and newer oral P2Y12 inhibitors (prasugrel, ticagrelor). Rates of the primary outcome (acute stent thrombosis) were examined as a function of the P2Y12 inhibitor used for loading and 30-day outcomes (including major adverse cardiac events) as a function of the P2Y12 inhibitor used for maintenance therapy. Logistic regression was used to adjust for differences in baseline characteristics.Results: Prasugrel or ticagrelor was given as the loading P2Y12 inhibitor in 49% of 2198 patients and as a maintenance therapy in 59%. No differences were observed in rates of acute stent thrombosis for clopidogrel versus newer P2Y12 inhibitors (adjusted OR 0.50, 95% CI 0.13 to 1.85). After adjustment, no difference was observed in 30-day outcomes according to maintenance therapy except for protocol major (p=0.029) or minor (p=0.025) bleeding and Thrombolysis In Myocardial Infarction minor bleeding (p=0.002), which were less frequent in patients on clopidogrel. Consistent results were observed in the bivalirudin and heparin arms.Conclusions: The choice of prasugrel or ticagrelor over clopidogrel was not associated with differences in acute stent thrombosis or 30-day ischaemic outcomes after pPCI.Trial registration number: NCT01087723.

U2 - 10.1136/openhrt-2017-000677

DO - 10.1136/openhrt-2017-000677

M3 - Journal article

C2 - 29225903

SN - 2053-3624

VL - 4

JO - Open Heart

JF - Open Heart

IS - 2

M1 - e000677

ER -

Early clinical outcomes as a function of use of newer oral P2Y inhibitors versus clopidogrel in the EUROMAX trial

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