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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:952-9 - Vol. 70 Num.11 DOI: 10.1016/j.rec.2017.05.003

Safety and Efficacy of Prasugrel and Ticagrelor in Acute Coronary Syndrome. Results of a “Real World” Multicenter Registry

Manuel Almendro-Delia a,, Ángel García-Alcántara b, M. Victoria de la Torre-Prados b, Antonio Reina-Toral c, José Andrés Arboleda-Sánchez d, Michel Butrón-Calderón a, Alberto García-Guerrero a, Rafael de la Chica-Ruiz Ruano c, Rafael Hidalgo-Urbano a, Juan C. García-Rubira a

a Unidad Coronaria, UGC Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Unidad de Cuidados Intensivos, Complejo Hospitalario Virgen de la Victoria, Málaga, Spain
c Unidad de Cuidados Intensivos, Complejo Hospitalario Universitario de Granada, Granada, Spain
d Unidad de Cuidados Intensivos, Hospital Regional Universitario de Málaga, Málaga, Spain


Registry. Real world. Prasugrel. Ticagrelor. Propensity score.


Introduction and objectives

The incorporation of the new antiplatelet agents (NAA) prasugrel and ticagrelor into routine clinical practice is irregular and data from the “real world” remain scarce. We aimed to assess the time trend of NAA use and the clinical safety and efficacy of these drugs compared with those of clopidogrel in a contemporary cohort of patients with acute coronary syndromes (ACS).


A multicenter retrospective observational study was conducted in patients with ACS admitted to coronary care units and prospectively included in the ARIAM-Andalusia registry between 2013 and 2015. In-hospital rates of major cardiovascular events and bleeding with NAA vs clopidogrel were analyzed using propensity score matching and multivariate regression models.


The study included 2906 patients: 55% received clopidogrel and 45% NAA. A total of 60% had ST-segment elevation ACS. Use of NAA significantly increased throughout the study. Patients receiving clopidogrel were older and were more likely to have comorbidities. Total mortality, ischemic stroke, and stent thrombosis were lower with NAA (2% vs 9%, P < .0001; 0.1% vs 0.5%, P = .025; 0.07% vs 0.5%, P = .025, respectively). There were no differences in the rate of total bleeding (3% vs 4%; P = NS). After propensity score matching, the mortality reduction with NAA persisted (OR, 0.37; 95%CI, 0.13 to 0.60; P < .0001) with no increase in total bleeding (OR, 1.07; 95%CI, 0.18 to 2.37; P = .094).


In a “real world” setting, NAA are selectively used in younger patients with less comorbidity and are associated with a reduction in major cardiac events, including mortality, without increasing bleeding compared with clopidogrel.


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1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved