Effects of ticagrelor in patients with acute coronary syndrome on the targets of the national cardiovascular program

Aim. To assess the effect of dual antiplatelet therapy (DAPT) including acetylsali-cylic acid and P2Y12 receptor blockers ticagrelor and clopidogrel in patients with acute coronary syndrome (ACS) with interventional and conservative management on the targets of the national cardiovascular program: 1) cardiovascular mortality, 2) myocardial infarction mortality.

Material and methods. The patients were divided into two cohorts: with the invasive or conservative management used. Patients after ACS followed by percutaneous coronary intervention (PCI) were included in the invasive management cohort, while patients without PCI constituted the conservative management cohort. To determine the effect of DAPT with ticagrelor and clopidogrel on mortality and th ncidence of cardiovascular events in the above cohorts, two sub-analyzes of PLATO study were used: in a subgroup of invasive management patients and in a subgroup of conservative management patients. Based on mortality rates, depending on the management strategy, the number of deaths that can be prevented by using ticagre-lor instead of clopidogrel was calculated. Then we calculated the proportion of national cardiovascular program targets that could be achieved in 2020 by using DAPT with ticagrelor instead of clopidogrel.

Results. The 1-year use of DAPT with ticagrelor for the management of ACS in accordance with clinical guidelines will allow (compared with clopidogrel):

•             to prevent an additional 7199 cardiovascular deaths per year, which will ensure achievement of 25% target for reducing mortality from CVD in Russian Federation in 2020;

•             to prevent an additional 1278 deaths from recurrent myocardial infarction, which will ensure achievement of 63% target for reducing mortality from myocardial infarction in the Russian Federation in 2020.

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