Risk factors for the primary effectiveness endpoint in secondary prevention of acute coronary syndrome with antiplatelet agents: A cohort in the nationwide French claims and hospitalisation database - 05/01/18
, J. Jové 2, R. Lassalle 2, C. Droz-Perroteau 2, F. Thomas-Delecourt 7, J. Dallongeville 8, N. Moore 2, 5Résumé |
Background |
The French HTA agency requested a real-life benefit-risk study of ticagrelor (T) compared to clopidogrel (C) and prasugrel (P) in the secondary prevention of acute coronary syndrome (ACS) (EUPAS5987).
Purpose |
This study aimed to identify the risk factors associated with the primary effectiveness endpoint for patients with antiplatelet agents after a hospitalisation for ACS.
Methods |
Patients hospitalised in 2013 for STEMI, NSTEMI or unstable angina, with intensive care unit (ICU) stay, and followed for 1 year in the nationwide French claims and hospitalisation database, SNIIRAM. Treatment group (T, C, or P±aspirin) was defined by the first drug dispensed in the month after discharge. The primary effectiveness endpoint was a composite of the first event of ACS with ICU stay, stroke, or all-cause death. Hazard ratios were estimated with Cox proportional hazard risk model (multivariate analysis).
Results |
A total of 41,954 patients were included (19,796 C, 13,916 T, 8242 P) with different characteristics: mean age of 72, 63, 58 years, respectively; 68%, 76%, 86% male; 42%, 55%, 72% STEMI. A Charlson comorbidity index>5 was associated with a risk increased by at least 50% for the primary effectiveness endpoint; age, a poverty index, ICU stay duration>5 days and no PCI during index hospitalisation, and congestive heart failure, peripheral arterial disease, ischemic stroke, abnormal renal function, C and P before index hospitalisation were associated with a risk increased by 20–50%; diabetes, hypertension, aspirin before index hospitalisation, and C in the month after discharge (versus T) were associated with a risk increased by 10–20%.
Conclusions |
In this nationwide real-life study, the risk factor most associated with the primary effectiveness endpoint was a Charlson comorbidity index>5.
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Vol 10 - N° 1
P. 9 - janvier 2018 Retour au numéro
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