1208Efficacy and safety of ticagrelor in comparison to clopidogrel in elderly patients with ST-segment elevation myocardial infarctions

Abstract

Introduction: The new generation platelet aggregation inhibitors prasugrel and ticagrelor have been incorporated in current recommendations for patients with acute myocardial infarctions. Only ticagrelor however is recommended for elderly patients (≥75 yrs.) admitted with ST‐elevation myocardial infarction (STEMI). Aim of the present study was to assess, how the usage of ticagrelor in the elderly led to better outcomes and if bleeding rates were affected. Methods: All consecutive patients ≥75 years admitted in a german heart center between 2006‐ Sep.2016 with STEMI and treated with primary PCI entered analysis. Results: Of a total of 1432 patients with STEMI ≥75 years analyzed, 936 (65%) were treated with clopidogrel while 496 (35%) received ticagrelor. Before ticagrelor was introduced in 2011 >99% of patients were treated with clopidogrel while after 2011 in 65% ticagrelor was used. Distribution of age, gender or infarction‐severity did not differ between cohorts treated with clopidogrel or ticagrelor. However rates of atrial fibrillation (AFib) as well as initiation of triple therapy were higher in the clopidogrel‐group (table). Treatment with ticagrelor was associated with lower 1‐year‐mortality as well as 1‐year‐MACCE‐rates (MACCE: death, reinfarction, cerebral event, target‐lesion/‐vessel‐revascularisation), even when excluding patients with initial AFib or triple therapy from analysis (1‐yearmortality 26 vs. 19%, 1‐year‐MACCE 32 vs. 24%, p<0.01). When adjusting outcome to confounders in a Cox‐regression‐model (adjusted to age, gender, Killip 2‐4, peak CK, Diabetes, PCI‐result, known CAD) the benefit for ticagrelor persisted as a trend (1‐yr‐mortality: HR 0.77 95% CI 0.6‐1.04, p=0.08, 1‐yr‐MACCE: HR 0.79 95% CI 0.6‐1.03, p=0.076). The choice between clopidogrel and ticagrelor did not affect bleeding rates (table). Conclusions: This registry‐data shows, that since 2011 ticagrelor was used in the majority of elderly patients admitted with STEMI. While patient populations treated with ticagrelor or clopidogrel were similar regarding age and sex, those treated with ticagrelor showed lower mortality as well as adverse‐event‐rates after one year while bleeding rates were similar. These results underline the efficacy and safety of ticagrelor in elderly patients admitted with STEMI.