Impact of Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a Propensity Score-Matched Analysis of the Amis-Plus Registry

Objective: To investigate outcomes of patients treated with prasugrel or clopidogrel after percutaneous coronary intervention (PCI) in a nationwide acute coronary syndrome (ACS) registry. Background: Prasugrel showed superior efficacy compared to clopidogrel in a randomized trial of ACS patients undergoing PCI. However, little is known about their efficacy in everyday practice. Methods: All ACS patients undergoing PCI enrolled in the Swiss AMIS-Plus registry between January 2010 and December 2013 were included in this analysis. Patients were stratified according to treatment with prasugrel or clopidogrel and outcomes were compared using propensity score matching. The primary endpoint was a composite of death, recurrent infarction and stroke at hospital discharge. Results: Out of 7’621 patients, 2’891 received prasugrel (38%) and 4’730 clopidogrel (62%). Independent predictors of in-hospital mortality were age, Killip class >2, STEMI, Charlson comorbidity index >1, and resuscitation prior to admission. Aft...