Lower CV event rates in European RWE ACS registries than in phase III P2Y12 inhibitor trials

Use, patient selection and outcomes of P2Y12 receptor inhibitor treatment in patients with STEMI based on contemporary European registries

Literature - Danchin N et al., Eur Heart J Cardiovasc Pharmacother 2016

Danchin N, Lettino M, Zeymer U, et al on behalf of the PIRAEUS group
Eur Heart J Cardiovasc Pharmacother. First published online: 27 January 2016

After the announcement of the project in their earlier methodology paper, the Platelet inhibition Registry in ACS EvalUation Study’ (PIRAEUS) group has now published the first data analyses in Eur Heart J Cardiovasc Pharmacother. PIRAEUS is a European initiative which aims to benefit from the many national ACS registries.

Many of the individual registries are too small to yield valuable insights on optimal care and therapy in acute coronary syndromes (ACS) patients who undergo percutaneous coronary intervention and who receive antiplatelet therapy. The PIRAEUS groups set out to gather and combine as much of these valuable real-world data as possible, in order to add to the existing clinical experience.

This first data review paper focusses on RWE data in patients with ST-segment elevation myocardial infarction (STEMI). Twelve European registries could provide data on outcomes in STEMI patients, and seven registries allowed stratification based on the type of P2Y12-receptor inhibitor received.

Death, ischaemic events and bleeding rates were lower in these contemporary registries than in the P2Y12-receptor inhibitor phase III studies. Differences were observed in bleeding rates between types of therapy. Heterogeneity of definitions of bleedings was noted among registries. Furthermore, due to differences in age and other CV risk factors, outcomes between treatment groups should be compared with great caution.

The newer P2Y12-receptor inhibitors ticagrelor and prasugrel are generally used in younger and less ill patients, which may have accounted for the low event rates. Alternatively, this mode of use may cause an underestimation of their antithrombotic potential.

Standardisation of data collection will facilitate pooled analysis of RWE registry data in the future.
Read the full paper for detailed comparisons of the registry data.

Find this article in Eur Heart J Cardiovasc Pharmacother

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