Incidencia anual de trombosis del stent confirmadas y factores clínicos predictores en pacientes con SCA tratados con ticagrelor o prasugrel
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Sergio Raposeiras-Roubín [8] ; Emad Abu-Assi [8] ; Fabrizio D'Ascenzo [9] ; Saleta Fernández-Barbeira [8] ; Tim Kinnaird [1] ; Albert Ariza-Solé [2] ; Sergio Manzano-Fernández [3] ; Christian Templin [10] ; Lazar Velicki [11] ; Ioanna Xanthopoulou [12] ; Enrico Cerrato [13] ; Giorgio Quadri [14] ; Andrea Rognoni [15] ; Giacome Boccuzzi [16] ; Andrea Montabone [16] ; Salma Taha [4] ; Alessandro Durante [5] ; Sebastiano Gili [10] ; Giulia Magnani [10] ; Michele Autelli [9] ; Alberto Grosso [9] ; Pedro Flores Blanco [3] ; Alberto Garay [2] ; Ferdinando Varbella [14] ; Francesco Tommassini [14] ; Berenice Caneiro Queija [8] ; Rafael Cobas Paz [8] ; María Cespón Fernández [8] ; Isabel Muñoz Pousa [8] ; Diego Gallo [6] ; Umberto Morbiducci [6] ; Alberto Domínguez-Rodríguez [7] ; José Antonio Baz-Alonso [8] ; Mariano Valdés [3] ; Ángel Cequier [2] ; Fiorenzo Gaita [9] ; Dimitrios Alexopoulos [12] ; Andrés Íñiguez-Romo [8]
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[1] University Hospital of Wales
University Hospital of Wales
Castle, Reino Unido
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[2] Hospital Universitari de Bellvitge
Hospital Universitari de Bellvitge
l'Hospitalet de Llobregat, España
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[3] Hospital Virgen de la Arrixaca
Hospital Virgen de la Arrixaca
Murcia, España
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[4] Assiut University
Assiut University
Egipto
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[5] Ospedale Valduce
Ospedale Valduce
Como, Italia
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[6] Polytechnic University of Turin
Polytechnic University of Turin
Torino, Italia
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[7] Hospital Universitario de Canarias
Hospital Universitario de Canarias
San Cristóbal de La Laguna, España
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[8] Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
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[9] Department of Cardiology, Department of Medical Sciences, University of Torino, Turín, Italia
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[10] Department of Cardiology, University Heart Center, University Hospital Zurich, Zúrich, Suiza
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[11] Medical Faculty, University of Novi Sad, Novi Sad, Serbia / Institute of Cardiovascular Diseases Voivodina, Sremska Kamenica, Serbia
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[12] University Patras Hospital, Atenas, Rion, Patras, Grecia
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[13] Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turín, Italia
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[14] Department of Cardiology, Infermi Hospital, Rivoli, Italia
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[15] Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italia
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[16] Department of Cardiology, S.G. Bosco Hospital, Turín, Italia
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- Localización: Revista española de cardiología, ISSN 0300-8932, Vol. 72, Nº. 4, 2019, págs. 298-304
- Idioma: español
- Títulos paralelos:
- Annual Incidence of Confirmed Stent Thrombosis and Clinical Predictors in Patients With ACS Treated With Ticagrelor or Prasugrel
- Enlaces
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Resumen
- español
Introducción y objetivos Hay muy poca evidencia sobre las tasas de trombosis del stent (TS) en pacientes que reciben tratamiento antiagregante plaquetario doble (TAPD) con ticagrelor o prasugrel. El objetivo de este estudio es analizar la incidencia y predictores de la TS tras un síndrome coronario agudo en pacientes que reciben TAPD con ticagrelor frente a prasugrel.
Métodos Se utilizaron datos del registro RENAMI (REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction), y se analizó en total a 4.123 pacientes con síndrome coronario agudo dados de alta con TAPD con ticagrelor o prasugrel en 11 centros de 6 países europeos. Se consideró como evento la TS confirmada en el primer año. Se realizó un análisis de riesgos competitivos mediante un modelo de regresión de Fine y Gray, siendo la muerte el evento competitivo.
Resultados Recibieron TAPD con ticagrelor 2.604 pacientes y con prasugrel, 1.519; 41 pacientes (1,10%) presentaron TS, con incidencias acumuladas similares entre ticagrelor (1,21%) y prasugrel (0,90%). Los predictores independientes de la TS fueron: la edad (sHR = 1,03; IC95%, 1,01-1,06), la elevación del segmento ST (sHR = 2,24; IC95%, 1,22-4,14), el antecedente de infarto de miocardio (sHR = 2,56; IC95%, 1,19-5,49) y la creatinina sérica (sHR = 1,29; IC95%, 1,08-1,54).
Conclusiones La TS es infrecuente en pacientes que reciben TAPD con ticagrelor y prasugrel. La edad avanzada, la elevación del segmento ST, el antecedente de infarto y la creatinina sérica son las variables que se asocian con mayor riesgo de TS.
- English
Introduction and objectives There is little evidence on rates of stent thrombosis (ST) in patients receiving dual antiplatelet therapy (DAPT) with ticagrelor or prasugrel. The aim of this study was to analyze the incidence and predictors of ST after an acute coronary syndrome among patients receiving DAPT with ticagrelor vs prasugrel.
Methods We used data from the RENAMI registry (REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction), analyzing a total of 4123 acute coronary syndrome patients discharged with DAPT with ticagrelor or prasugrel in 11 centers in 6 European countries. The endpoint was definite ST within the first year. A competitive risk analysis was carried out using a Fine and Gray regression model, with death being the competitive event.
Results A total of 2604 patients received DAPT with ticagrelor and 1519 with prasugrel; ST occurred in 41 patients (1.10%), with a similar cumulative incidence between ticagrelor (1.21%) and prasugrel (0.90%). The independent predictors of ST were age (sHR, 1.03; 95%CI, 1.01-1.06), ST segment elevation (sHR, 2.24; 95%CI, 1.22-4.14), previous myocardial infarction (sHR, 2.56; 95%CI, 1.19-5.49), and serum creatinine (sHR, 1.29; 95%CI, 1.08-1.54).
Conclusions Stent thrombosis is infrequent in patients receiving DAPT with ticagrelor or prasugrel. The variables associated with an increased risk of ST were advanced age, ST segment elevation, previous myocardial infarction, and serum creatinine.
- español
