Title: 464 Comparison of Potent Anti-Platelet Agents in Acute Coronary Syndrome
Abstract: The use of ticagrelor or prasugrel with aspirin after acute coronary syndromes (ACS) reduces recurrent ischaemic events compared to clopidogrel. There are limited data exploring this in unselected Australian populations. To determine whether the findings of randomised trials of ADP receptor antagonists can be extrapolated to a real-world population. CONCORDANCE (Cooperative National Registry of ACS, Guideline Adherence and Clinical Events) patient data from 43 Australian sites were stratified by 1st antiplatelet agent received. Differences in death, MACE (cardiovascular death, MI or stroke) and bleeding in-hospital and at 6 months after multivariable adjustment were compared. Mean ages of the Clopidogrel (n=7537), Ticagrelor (n=1878), and Prasugrel (n=347) cohorts were 65, 63, and 58 years (p<0.0001), and mean GRACE risk scores were 107, 104, and 102 (p=0.0016). The Ticagrelor and Prasugrel cohorts were more likely to receive PCI (Clopidogrel 52%, Ticagrelor 66%, Prasugrel 88%, p<0.0001), and ≥4 indicated medications (Clopidogrel 76%, Ticagrelor 82%, Prasugrel 93%, p<0.0001) Following adjustment, patients treated with Ticagrelor were less likely to experience in-hospital death (aOR 0.54, 95% CI 0.34-0.86), or MACE (aOR 0.65, 95% CI 0.48-0.88) with no excess in bleeding (aOR 0.75, 95% CI 0.53-1.06) compared to Clopidogrel. No difference was seen between Prasugrel and Clopidogrel. There was no difference in outcomes by 6 months. In Australia newer ADP-antagonists are used in younger, more aggressively managed patients. Patients prescribed Ticagrelor had superior in-patient outcomes than those on Clopidogrel which was attenuated at 6-month follow-up.