6011Outcomes in patients treated with ticagrelor versus clopidogrel after acute myocardial infarction in relation to renal function: 1-year SWEDEHEART registry data

Abstract

Background: Clinical outcome data on antithrombotic drugs in patients with renal dysfunction is scarce since they are often excluded from randomized clinical trials. Comparative effectiveness data from real-world registries can therefore provide important additional insights. Objectives: We evaluated outcomes of ticagrelor and clopidogrel in relation to renal function in a large cohort of myocardial infarction (MI) patients. Methods: Follow-up data in MI survivors from 1 Jan 2010 to 31 Dec 2013 discharged on ticagrelor or clopidogrel enrolled in the Swedish MI registry (SWEDEHEART) was evaluated. The association between ticagrelor versus clopidogrel and the composite outcome of death, MI, stroke, and bleeding (defined as rehospitalizations with bleeding) at 1-year was studied using Cox proportional hazards models, adjusting for hospital, calendar time, baseline characteristics, inhospital complications and treatments and other medications at discharge and stratifying for renal function (eGFR). To study in-hospital bleeds in patients undergoing percutaneous coronary intervention (PCI) (n=36,392), logistic regression analysis was used, adjusting for hospital, calendar time, baseline characteristics, antithrombotic treatment during PCI and vascular access. Results: In total, 45,206 MI patients discharged on clopidogrel (n=33,472) or ticagrelor (n=11,734) were included. The unadjusted 1-year cumulative probability for the combined endpoint of MI, death or stroke was 7.0%, 18.0% and 48.0% for ticagrelor treatment and 11.0%, 33.0% and 64.0% for clopidogrel treatment in patients with eGFR>60 (n=33,668), eGFR30-60 (n=9,803), and eGFR<30 (n=1,735), respectively. After adjustment, ticagrelor was associated with a lower 1-year risk of the composite outcome and death, and a higher risk of bleeding as compared to clopidogrel (figure). The point estimates for patients with eGFR<30 indicated a lower risk of MI, a higher risk of bleeding and no difference regarding the composite endpoint and death when ticagrelor was compared with clopidogrel, but all confidence intervals were wide and a significant interaction was only present regarding death. Conclusions: Impaired renal dysfunction was associated with markedly higher ischemic risk. Treatment with ticagrelor vs clopidogrel in MI patients was associated with lower risk for the combined endpoint of death, MI or stroke in patients with normal and moderately reduced renal function. There is a need for more studies in patients with advanced renal dysfunction. (Figure Presented).