P6409Ticagrelor and prasugrel versus clopidogrel in patients with acute coronary syndromes and chronic renal dysfunction: safety and efficacy

• Published in: European heart journal Vol. 40; no. Supplement_1
• Main Authors: De Filippo, O, D'Ascenzo, F, Raposeiras-Roubin, S, Peyracchia, M, Gili, S, Iannaccone, M, Ariza-Sole, A, Abu-Assi, E, Liebetrau, C, Manzano-Fernandez, S, Montabone, A, Henriques, J P S, Quadri, G, Giustetto, C, Rinaldi, M
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.10.2019
• Subjects: Coronary Artery Disease: Pharmacotherapy
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz746.1003

Abstract Introduction Safety and efficacy of prasugrel and ticagrelor in real-life ACS (Acute Coronary Syndrome) with renal dysfunction remain to be established. Methods Consecutive patients from RENAMI and BLEEMACS were stratified according to renal function and estimated glomerular filtration rate (eGFR<60 mL/min/1.73 m2). Myocardial infarction (MI) and BARC major bleedings (MB; BARC type 3 or 5) were the primary end-point. Independent impact of clopidogrel, prasugrel and ticagrelor were evaluated with Cox multivariate analysis. Results 19255 patients were enrolled (mean eGFR: 90±39 ml/min/1.73m2). Patients with eGFR<60 mL/min/1.73m2, constituted the 12.9% of the population (2490 pts). After a mean follow up of 13±5 months, the global incidence of re-AMI was of 5.8% and 2.9% in patients with and in those without eGFR<60 mL/min/1.73m2 (p<0.0001) respectively. MB occurred in 5.7% and 3% (p<0.0001). At Cox multivariate analysis, clopidogrel compared to prasugrel and ticagrelor was associated with increased risk of MI both in those with eGFR>60 mL/min/1.73m2 (HR=3.3: 2.4–4.4, p<0.0001) as well as in patients with eGFR<60 mL/min/1.73m2 (HR=10.04: 3.1–32.3, p<0.0001). In contrast, both prasugrel (HR=0.07: 0.01–0.54, p=0.01) and Ticagrelor (HR=0.36: 0.16–0.81, p=0.01) were associated with decreased risk of MI in the latters. DAPT with ticagrelor or prasugrel did not increased risk of MB in patients with eGFR<60 mL/min/1.73m2, while in patients with eGFR>60 mL/min/1.73m2, ticagrelor was associated to a slightly higher risk of MB (HR=1.43: 1.09–1.89, p=0.009). Conclusion In ACS patients with eGFR<60 mL/min/1.73m2, prasugrel and ticagrelor are associated with lower risk of recurrent MI without significant increase in the risk of MB.