Abstract
ObjectiveTo estimate the absolute treatment effects of newer P2Y12 inhibitors (ticagrelor and prasugrel) compared to clopidogrel in men and women with acute coronary syndrome (ACS).MethodsWe searched Ovid MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomised controlled trials of oral P2Y12 inhibitors for acute stroke or ACS. Age and sex-specific mortality was obtained for all patients admitted to hospital with myocardial infarction in Scotland from 2006 to 2010 (prior to introduction of prasugrel or ticagrelor).ResultsFrom 9,277 articles, 9 fulfilled our inclusion criteria. Three trials compared newer P2Y12 inhibitors to clopidogrel in ACS, in which the treatment rate ratio (RR) for major adverse cardiovascular events in men was 0.80 (95% CI 0.69 to 0.93). For the same outcome, across all 9 trials the sex-treatment interaction RR was 1.08 (95% CI 0.98 to 1.19). Combining these estimates yielded a treatment RR in women of 0.86 (95% CI 0.72 to 1.04). 17,842 women and 27,818 men were admitted to hospital with myocardial infarction. Mortality was higher for women than men for all-cause (5708, 32.0% versus 5891,21.2%), cardiovascular(4032, 22.6% versus 4117, 14.8%) and bleeding (193, 1.1% versus 228, 0.8%) deaths. On applying the sex-specific RRs to this population, the absolute risk reduction for mortality at 1- year was similar for women and men for all-cause (2.30% (95% CI -0.92 to 5.22) versus 2.47% (95% CI 0.62 to 4.10)), cardiovascular (2.70% (95% CI -0.63 to 5.74)) versus 2.72% (95% CI 0.92 to 4.35)) and bleeding (-0.27% (95% CI -1.06 to 0.30) versus -0.18% (95% CI -0.71 to 0.24)) deaths.ConclusionNewer P2Y12 inhibitors may be slightly less efficacious in women than men, but the absolute risk reduction is similar in both sexes.
| Original language | English |
|---|---|
| Pages (from-to) | 657-664 |
| Number of pages | 8 |
| Journal | Heart |
| Volume | 104 |
| Issue number | 8 |
| Early online date | 5 Oct 2017 |
| DOIs | |
| Publication status | Published - 23 Mar 2018 |
Bibliographical note
Funding Information:from the Wellcome trust (201492-Z-16-Z). nlM and Den are supported by the Butler senior research Fellowship (Fs/16/14/32023) and chair (ch/09/002) awards from the British heart Foundation. Den is the recipient of a Wellcome trust senior investigator award (Wt103782aia). nhs information services Division provided data on the scottish population. staff from the clinical research using linked Bespoke studies and electronic health records (caliBer) project provided a list of diagnostic and procedure codes for defining bleeding. Contributors KKl, as, nlM and DM conceived and designed the study. DM conducted the statistical analysis and interpreted the results. sD and nW advised on the design and conduct of the statistical analysis and the interpretation of the results. KKl, as and PDa conducted the systematic review. KKl and DM initially drafted the manuscript. all authors interpreted the findings, made critical revisions of the manuscript for intellectual content and had final approval of the version published.
Funding Information:
Funding this work was supported by the Wellcome trust (201492-Z-16-Z and Wt103782aia) and British heart Foundation (Fs/16/14/32023 and ch/09/002).
Publisher Copyright:
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.
Keywords
- acute coronary syndromes
- acute myocardial infarction
- epidemiology and meta-analysis