Korean Circ J.  2017 Nov;47(6):888-897. 10.4070/kcj.2017.0072.

The Use Pattern and Clinical Impact of New Antiplatelet Agents Including Prasugrel and Ticagrelor on 30-day Outcomes after Acute Myocardial Infarction in Korea: Korean Health Insurance Review and Assessment Data

• Kim C
• Shin DH
• Ahn CM
• Kim JS
• Kim BK
• Ko YG
• Choi D
• Hong MK
• Park J
• Lee H
• Choi YJ
• Choi YS
• Oh SK
• Jang Y

• KMID: 2396482
• DOI: http://doi.org/10.4070/kcj.2017.0072

Abstract

BACKGROUND AND OBJECTIVES
Despite the favorable efficacy of new antiplatelet agents demonstrated in randomized controlled trials, their clinical implications in Korea are unclear. The purpose of this study was to investigate trends in antiplatelet agent use for acute myocardial infarction (AMI) and their impact on 30-day clinical outcomes.
METHODS
AMI patients undergoing percutaneous coronary intervention between 2010 and 2015 were assessed using claim data from the Health Insurance Review and Assessment Service.
RESULTS
The use of new antiplatelet agents has rapidly increased since 2013 and has been preferred over clopidogrel (Plavix; Bristol-Myers Squibb/Sanofi Pharmaceuticals) since 2015. Both prasugrel (Effient; Eli Lilly and Company) (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.31-0.67; p < 0.001) and ticagrelor (Brilinta; AstraZeneca Pharmaceuticals LP) (OR, 0.84; 95% CI, 0.71-0.98; p=0.032) had an independent effect on lowering 30-day mortality in a weighted multivariable logistic regression model. However, new antiplatelet agents had no significant effect on other clinical outcomes including myocardial infarction, stroke, bleeding, and readmission within 30 days.
CONCLUSION
The use of new antiplatelet agents is rapidly increasing, and they have been used more commonly than clopidogrel since 2015. We demonstrated that new antiplatelet agents have a favorable effect on reducing 30-day mortality in AMI patients in Korea.

Keyword

Myocardial infarction; Prasugrel; Ticagrelor; Clopidogrel; Percutaneous coronary intervention

MeSH Terms

Hemorrhage
Humans
Insurance, Health*
Korea*
Logistic Models
Mortality
Myocardial Infarction*
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors*
Prasugrel Hydrochloride*
Stroke
Platelet Aggregation Inhibitors
Prasugrel Hydrochloride

Figure

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  Figure 1 The use of P2Y12 antagonists in patients with AMI. Trends over time of P2Y12 antagonist use (A) and proportion of these prescriptions during 2010–2012 and 2013–2015 (B). Density plot indicates the age distribution of the 3 antiplatelet agents clopidogrel, prasugrel, and ticagrelor before (C) and after (D) 75 years of age. Orange indicates clopidogrel, green indicates prasugrel, and red indicates ticagrelor. AMI = acute myocardial infarction.

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