SPC365

Comparative In-Hospital Outcomes of P2Y12 Inhibitors Following Acute Coronary Syndromes: Evidence from the ProACS Registry

Session: SESSÃO DE POSTERS 37 - DOENÇAS CARDIOVASCULARES - TERAPÊUTICA ANTITROMBÓTICA
Speaker: Ana Inês Aguiar Neves

Congress: CPC 2025
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.4 Acute Coronary Syndromes – Treatment
Session Type: Cartazes
FP Number: ---
Authors: Ana Inês Aguiar Neves; Marta Leite; Rafael Silva Teixeira; Fábio Sousa Nunes; Marta Ponte; Marisa Passos Silva; Adelaide Dias; Daniel Caeiro; Ricardo Fontes-Carvalho; Portuguese Registry of Acute Coronary Syndromes Investigators

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Background</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">: The choice of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) may influence in-hospital outcomes in patients with acute coronary syndromes (ACS). This study aims to retrospectively evaluate the comparative effectiveness of the second antiplatelet agent with regard to in-hospital mortality, reinfarction and bleeding events using data from a Portuguese registry.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">: Patients with a diagnosis of&nbsp; ACS upon hospital admission who were enrolled in the ProACS registry between January 2011 and December 2023 were included if they underwent PCI and received DAPT with aspirin and a P2Y12 inhibitor (clopidogrel, ticagrelor or prasugrel) during the index hospitalization. Patients treated conservatively, referred for surgical revascularization, or with missing data regarding the therapeutic strategy were excluded. Incidences of reinfarction, cerebrovascular events, bleeding complications, and arrhythmias were compared across the three groups.&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Results</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">: Among 12 147 patients (24.3% female), clopidogrel was the most commonly prescribed P2Y12 inhibitor (67%), followed by ticagrelor (32%) and prasugrel (1%). In comparison with ticagrelor or prasugrel, clopidogrel was more frequently prescribed in older patients (median age 65.7 [IQR 55.7-75.7] years for clopidogrel, 62.8 [IQR 53.9-71.5] years for ticagrelor and 57.3 [IQR 52.1-64.7] years for prasugrel) and in patients with comorbidities including diabetes and hypertension. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">When compared to the ticagrelor group, patients on clopidogrel were more likely to have significant left main disease (6.6% vs. 4.9%), have a reduced left ventricular ejection fraction (40.5% vs. 28.1%), have a higher median BNP level (267 [IQR 114, 641] pg/ml vs 111.5 [IQR 43, 288] pg/ml), require inotropic therapy (4.6% vs 2.8%) and to have undergone femoral access for invasive coronary angiography (37.9% vs. 10.0%; <em><span style="font-family:&quot;Arial&quot;,sans-serif">p </span></em>&lt;0.001 for all).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Clopidogrel use was associated with higher rates of in-hospital mortality (2.2% vs. 1.2%, p &lt;0.001), cerebrovascular events (0.6% vs. 0.3%, p = 0.032), and major bleeding events (0.9% vs. 0.3%, p = 0.001) when compared to ticagrelor. No major bleeding events, cerebrovascular accidents or in-hospital mortality events were observed in the prasugrel group. Patients prescribed clopidogrel also experienced more frequent complications, including acute heart failure, arrhythmias, and cardiogenic shock, compared to those on ticagrelor or prasugrel (<em><span style="font-family:&quot;Arial&quot;,sans-serif">p</span></em> &lt;0.05 for all).&nbsp; </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusions</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">: In this cohort, patients prescribed clopidogrel after ACS tended to be older and present more comorbidities than those prescribed prasugrel or ticagrelor. Clopidogrel use was associated with worse in-hospital outcomes, which may reflect higher baseline risk and a greater number of comorbidities in these patients.</span></span></span></span></p>