5 years ago

Ninety-day Readmission and Long-Term Mortality in Medicare Patients (≥65 Years) Treated With Ticagrelor Versus Prasugrel After Percutaneous Coronary Intervention (From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium)

Ticagrelor and prasugrel were found to be superior to clopidogrel for the treatment of acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI); however, the comparative effectiveness of these 2 drugs remains unknown. We compared post-discharge outcomes among older patients treated with ticagrelor versus prasugrel after PCI for ACS. We linked clinical data from PCIs performed in older patients (age ≥65) for ACS at 47 Michigan hospitals to Medicare fee-for-service claims from January 1, 2013 through December 31, 2014 to ascertain rates of 90-day readmissions and long-term mortality. We used propensity score matching to adjust for the non-random use of ticagrelor and prasugrel at discharge. Logistic regression and Cox proportional hazards models were used to compare rates of 90-day readmission and long-term mortality, respectively. Patients discharged on ticagrelor (n=1,243) were more frequently older, female, had a history of cerebrovascular disease, and presented with ST- or non-ST-elevation myocardial infarction compared with prasugrel (n=1,014). After matching (n=756 per group), there were no significant differences in rates of 90-day readmission (16.7% ticagrelor vs 14.6% prasugrel; adjusted OR: 1.15; 95% CI: 0.86-1.55; P=0.35) or 1-year mortality (5.4% ticagrelor vs 3.7% prasugrel; HR 1.3; 95% CI: 0.8-2.2; P=0.31). In conclusion, we found no significant differences in the rates of 90-day readmission or long-term mortality between older patients treated with ticagrelor versus prasugrel after PCI for ACS. In the absence of randomized data to the contrary, these 2 treatments appear similarly effective.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917313796

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