P2Y12 Inhibitors in Acute Coronary Syndromes: A Real-World, Community-Based Comparison of Ischemic and Bleeding Outcomes

Table 6

Hazard ratio (HR) and 95 confidence interval (CI) comparing the effect of novel P2Y12 inhibitors (ticagrelor or prasugrel) to clopidogrel on adverse events at one-year follow-up.

	Ticagrelor vs clopidogrel, HR (95% CI)			Prasugrel vs clopidogrel, HR (95% CI)
	Unadjusted	Multivariable adjusted	Propensity adjusted	Unadjusted	Multivariable adjusted	Propensity adjusted
Mortality	0.49 (0.27–0.86)	0.67 (0.38–1.19)	0.43 (0.20–0.92)	0.83 (0.52–1.33)	1.54 (0.96–2.48)	1.42 (0.76–2.68)
Myocardial infarction	0.96 (0.67–1.37)	1.26 (0.87–1.81)	1.07 (0.68–1.68)	0.77 (0.51–1.18)	1.02 (0.67–1.57)	1.38 (0.81–2.34)
Stroke	0.75 (0.43–1.34)	1.19 (0.67–2.12)	1.52 (0.72–3.24)	0.50 (0.24–1.06)	0.94 (0.44–2.0)	0.94 (0.38–2.34)
Bleeding events	0.82 (0.51–1.34)	1.38 (0.85–2.25)	1.77 (0.94–3.31)	0.77 (0.45–1.31)	1.30 (0.76–2.23)	1.45 (0.75–2.80)

Multivariable proportional hazard (PH) regression models were developed for each outcome. For all outcomes, we controlled for demographics (age, gender, and race/ethnicity), precise DAPT score, medication adherence rate, creatinine, and hemoglobin. Additionally, for mortality, we controlled for prior myocardial infraction (MI), peripheral vascular disease, heart failure, diabetes, and chronic lung disease; for hospitalized MI, we controlled for prior MI, heart failure, diabetes, PCI indication, and anticoagulation use; for hospitalized stroke, we controlled for cerebrovascular disease, peripheral vascular disease, heart failure, diabetes, and anticoagulation use; for bleeding events, we controlled for peripheral vascular disease, heart failure, and anticoagulation. Baseline variables in propensity score (PS) matching include demographics (age, gender, and race/ethnicity), cardiovascular history (prior MI, prior CABG, cerebrovascular disease, peripheral vascular disease, heart failure, atrial fibrillation, hyperlipidemia, hypertension, and diabetes), smoking status, chronic kidney disease, chronic lung disease, and PCI indication. For the subsequent multivariable models, all variables in the PS models were included, with additional variables including race/ethnicity, creatinine, hemoglobin, and medication adherence rate for all outcomes. We also adjusted anticoagulation for all hospitalized events, and precise DAPT score for mortality, MI, and bleeding events.