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Vol. 72. Issue 4.
Pages 298-304 (April 2019)
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Vol. 72. Issue 4.
Pages 298-304 (April 2019)
Original article
DOI: 10.1016/j.rec.2018.05.021
Annual Incidence of Confirmed Stent Thrombosis and Clinical Predictors in Patients With ACS Treated With Ticagrelor or Prasugrel
Incidencia anual de trombosis del stent confirmadas y factores clínicos predictores en pacientes con SCA tratados con ticagrelor o prasugrel
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Sergio Raposeiras-Roubína, Emad Abu-Assia,
Corresponding author
eabuassi@gmail.com

Corresponding author: Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Clara Campoamor 341, 36212 Vigo, Pontevedra, Spain.
, Fabrizio D’Ascenzob, Saleta Fernández-Barbeiraa, Tim Kinnairdc, Albert Ariza-Soléd, Sergio Manzano-Fernándeze, Christian Templinf, Lazar Velickig,h, Ioanna Xanthopouloui, Enrico Cerratoj, Giorgio Quadrik, Andrea Rognonil, Giacome Boccuzzim, Andrea Montabonem, Salma Tahan, Alessandro Duranteo, Sebastiano Gilif, Giulia Magnanif, Michele Autellib, Alberto Grossob, Pedro Flores Blancoe, Alberto Garayd, Ferdinando Varbellak, Francesco Tommassinik, Berenice Caneiro Queijaa, Rafael Cobas Paza, María Cespón Fernándeza, Isabel Muñoz Pousaa, Diego Gallop, Umberto Morbiduccip, Alberto Domínguez-Rodríguezq, José Antonio Baz-Alonsoa, Mariano Valdése, Ángel Cequierd, Fiorenzo Gaitab, Dimitrios Alexopoulosi, Andrés Íñiguez-Romoa
a Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
b Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy
c Cardiology Department, University Hospital of Wales, Cardiff, Wales, United Kingdom
d Servicio de Cardiología, Hospital de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
e Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
f Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
g Medical Faculty, University of Novi Sad, Novi Sad, Serbia
h Institute of Cardiovascular Diseases Voivodina, Sremska Kamenica, Serbia
i University Patras Hospital, Atenas, Rion, Patras, Greece
j Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
k Department of Cardiology, Infermi Hospital, Rivoli, Italy
l Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
m Department of Cardiology, S.G. Bosco Hospital, Turin, Italy
n Department of Cardiology, Faculty of Medicine, Assiut University, Asiut, Egypt
o Unità Operativa di Cardiologia, Ospedale Valduce, Como, Italy
p PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
q Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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Figures (2)
Tables (3)
Table 1. Baseline Characteristics of the Study Population According to Whether the Dual Antiplatelet Therapy Involved Ticagrelor or Prasugrel
Table 2. Univariable Analysis of Stent Thrombosis in the First Year and in the First Month
Table 3. Multivariable Analysis for Predicting Stent Thrombosis in the First Year and Particularly in the First Month
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Additional material (1)
Abstract
Introduction and objectives

There is little evidence on rates of stent thrombosis (ST) in patients receiving dual antiplatelet therapy (DAPT) with ticagrelor or prasugrel. The aim of this study was to analyze the incidence and predictors of ST after an acute coronary syndrome among patients receiving DAPT with ticagrelor vs prasugrel.

Methods

We used data from the RENAMI registry (REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction), analyzing a total of 4123 acute coronary syndrome patients discharged with DAPT with ticagrelor or prasugrel in 11 centers in 6 European countries. The endpoint was definite ST within the first year. A competitive risk analysis was carried out using a Fine and Gray regression model, with death being the competitive event.

Results

A total of 2604 patients received DAPT with ticagrelor and 1519 with prasugrel; ST occurred in 41 patients (1.10%), with a similar cumulative incidence between ticagrelor (1.21%) and prasugrel (0.90%). The independent predictors of ST were age (sHR, 1.03; 95%CI, 1.01-1.06), ST segment elevation (sHR, 2.24; 95%CI, 1.22-4.14), previous myocardial infarction (sHR, 2.56; 95%CI, 1.19-5.49), and serum creatinine (sHR, 1.29; 95%CI, 1.08-1.54).

Conclusions

Stent thrombosis is infrequent in patients receiving DAPT with ticagrelor or prasugrel. The variables associated with an increased risk of ST were advanced age, ST segment elevation, previous myocardial infarction, and serum creatinine.

Keywords:
Ticagrelor
Prasugrel
Stent thrombosis
Acute coronary syndrome
Abbreviations:
ACS
AMI
DAPT
DES
PCI
ST
Resumen
Introducción y objetivos

Hay muy poca evidencia sobre las tasas de trombosis del stent (TS) en pacientes que reciben tratamiento antiagregante plaquetario doble (TAPD) con ticagrelor o prasugrel. El objetivo de este estudio es analizar la incidencia y predictores de la TS tras un síndrome coronario agudo en pacientes que reciben TAPD con ticagrelor frente a prasugrel.

Métodos

Se utilizaron datos del registro RENAMI (REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction), y se analizó en total a 4.123 pacientes con síndrome coronario agudo dados de alta con TAPD con ticagrelor o prasugrel en 11 centros de 6 países europeos. Se consideró como evento la TS confirmada en el primer año. Se realizó un análisis de riesgos competitivos mediante un modelo de regresión de Fine y Gray, siendo la muerte el evento competitivo.

Resultados

Recibieron TAPD con ticagrelor 2.604 pacientes y con prasugrel, 1.519; 41 pacientes (1,10%) presentaron TS, con incidencias acumuladas similares entre ticagrelor (1,21%) y prasugrel (0,90%). Los predictores independientes de la TS fueron: la edad (sHR = 1,03; IC95%, 1,01-1,06), la elevación del segmento ST (sHR = 2,24; IC95%, 1,22-4,14), el antecedente de infarto de miocardio (sHR = 2,56; IC95%, 1,19-5,49) y la creatinina sérica (sHR = 1,29; IC95%, 1,08-1,54).

Conclusiones

La TS es infrecuente en pacientes que reciben TAPD con ticagrelor y prasugrel. La edad avanzada, la elevación del segmento ST, el antecedente de infarto y la creatinina sérica son las variables que se asocian con mayor riesgo de TS.

Palabras clave:
Ticagrelor
Prasugrel
Trombosis del stent
Síndrome coronario agudo

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