Seguridad y eficacia clínica con prasugrel y ticagrelor en síndrome coronario agudo. Resultados de un registro multicéntrico en el mundo real

espanolIntroduccion y objetivos La incorporacion de los nuevos antiagregantes (NAA) prasugrel y ticagrelor a la practica clinica esta siendo erratica. Los datos del mundo real todavia son escasos. Se analizo la tendencia temporal de uso de NAA, su seguridad y eficacia clinica frente a clopidogrel en una cohorte actual de pacientes con sindrome coronario agudo (SCA). Metodos Estudio multicentrico observacional retrospectivo de pacientes con SCA ingresados en unidades coronarias incluidos de forma prospectiva en el registro ARIAM-Andalucia entre 2013 y 2015. Se analizaron las tasas de eventos cardiovasculares mayores y hemorragias intrahospitalarias mediante modelos de propension y regresion multivariante. Resultados Se incluyo a 2.906 pacientes: el 55% recibio clopidogrel y el 45% NAA. Un 60% presento SCA con elevacion del segmento ST. El uso de NAA se incremento de forma significativa a lo largo del estudio. El grupo de clopidogrel presento mayor edad y comorbilidad. La tasa de mortalidad total, el ictus isquemico y la trombosis del stent fue menor con NAA (2 frente a 9%, p Conclusiones En el mundo real, los NAA se usan de forma selectiva en sujetos mas jovenes y con menor comorbilidad. Su uso se asocia con una reduccion de eventos cardiacos mayores, incluida mortalidad, sin aumentar las hemorragias en comparacion con clopidogrel. EnglishIntroduction and objectives The incorporation of the new antiplatelet agents (NAA) prasugrel and ticagrelor into routine clinical practice is irregular and data from the “real world” remain scarce. We aimed to assess the time trend of NAA use and the clinical safety and efficacy of these drugs compared with those of clopidogrel in a contemporary cohort of patients with acute coronary syndromes (ACS). Methods A multicenter retrospective observational study was conducted in patients with ACS admitted to coronary care units and prospectively included in the ARIAM-Andalusia registry between 2013 and 2015. In-hospital rates of major cardiovascular events and bleeding with NAA vs clopidogrel were analyzed using propensity score matching and multivariate regression models. Results The study included 2906 patients: 55% received clopidogrel and 45% NAA. A total of 60% had ST-segment elevation ACS. Use of NAA significantly increased throughout the study. Patients receiving clopidogrel were older and were more likely to have comorbidities. Total mortality, ischemic stroke, and stent thrombosis were lower with NAA (2% vs 9%, P Conclusions In a “real world” setting, NAA are selectively used in younger patients with less comorbidity and are associated with a reduction in major cardiac events, including mortality, without increasing bleeding compared with clopidogrel.