Effect of ticagrelor in patients with acute coronary syndrome on the achievement of the targets of federal project on the prevention of cardiovascular diseases: 3-year perspective estimates

Aim. To assess the additional effect of ticagrelor as part of dual antiplatelet therapy (DAPT) compared with DAPT with clopidogrel and acetylsalicylic acid (ASA) monotherapy on the achievement of goals of federal project on the prevention of cardiovascular diseases: “reduction of cardiovascular mortality” and “reduction of mortality from myocardial infarction (MI)”.

Material and methods. In the first year of treatment, all adult Russian patients with documented acute coronary syndrome (ACS), who had indications for DAPT, were considered as the target population. In the second and third years, treat -ment was continued only by patients with a high risk of thrombotic events. The calculation of the number of deaths that can be prevented using DAPT with ti -cagrelor 90 mg + ASA instead of clopidogrel + ASA during the first year was based on the data of the PLATO trial. To calculate the number of deaths that can be prevented using DAPT with ticagrelor 60 mg + ASA instead of ASA monotherapy, we used the data of PEGASUS trial for patients with a history of MI within the past 2 years.

Then the proportion of goals that can be achieved in 2021-2023 was calculated when using DAPT with ticagrelor instead of clopidogrel or ASA monotherapy.

Results. The use of ticagrelor within DAPT for patients with ACS will allow (compared to DAPT with clopidogrel and ASA monotherapy):

— to prevent an additional 5389, 5702 and 6009 deaths in 2021, 2022, and 2023, respectively, achieving the target of federal project on the prevention of cardiovascular diseases “reduction of cardiovascular mortality” by 18,4, 19,4 and 20,5%, respectively.

In addition, the use of ticagrelor within DAPT for patients with ACS compared with clopidogrel or ASA monotherapy will also allow:

— to prevent an additional 957, 1013 and 1067 deaths due to MI in 2021, 2022, and 2023, respectively, achieving the target of federal project on the prevention of cardiovascular diseases “reduction of mortality from MI” by 50,2%, 49,3% and 51,9%, respectively.

Conclusion. The use of ticagrelor in patients with ACS will reduce cardiovascular mortality and contribute on the achievement of goals of federal project on the prevention of cardiovascular diseases.

1. Demographic Yearbook of Russia 2019 (the Demographic Yearbook of Russia). Federal state statistics service. (In Russ.) https://gks.ru/folder/210/document/13207.

2. Alekyan BG, Ganyukov VI, Manoshkina ЕМ, et al. Revascularization in ST-elevation myocardial infarction in the Russian Federation. Analysis of 2018 results. Russian Journal of Endovascular Surgery. 2019;6(2):89-97. (In Russ.) doi:10.24183/2409-4080-2019-6-2-89-97.

3. Passport of the national project “Healthcare” (approved by the Presidium of the Council under the President of the Russian Federation for strategic development and national projects, Protocol of December 24, 2018 N 16). (In Russ.) https://futurerussia.gov.ru/zdravoohranenie.

4. Passport of the Federal project “Fight against cardiovascular diseases”. (In Russ.) https://www.rosminzdrav.ru/poleznye-resursy/natsproektzdravoohranenie/bssz.

5. Data from the Central research Institute for health organization and Informatization of the Ministry of health of the Russian Federation. (In Russ.) https://box.almazovcentre.ru/index.php/s/EYpf3hPX5OrViHq?fbclid=IwAR3jBOaHp-tf3P13ztI7uUBAhjo1Jem6MYsFZ9RubSQbegl1wgrqp5uDVfs.

6. Resolution of the Government of the Russian Federation of 30.11.2019 N 1569 “On amendments to the state program of the Russian Federation “Development of healthcare”. (In Russ.) http://publication.pravo.gov.ru/Document/View/0001201912060020.

7. Order of the Ministry of health of the Russian Federation No. 1N of January 9, 2020 “on approval of the list of medicines for medical use to provide for one year on an outpatient basis for persons who have suffered acute cerebrovascular accident, myocardial infarction, and who have undergone coronary artery bypass grafting, angioplasty with stenting, and catheter ablation for cardiovascular diseases”. (In Russ.) https://www.garant.ru/products/ipo/prime/doc/73362529/.

8. 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020;25(11):4103. (In Russ.) doi:10.15829/1560-4071-2020-4103.

9. 2020 Clinical practice guidelines for Acute myocardial infarction without ST-segment elevation. (In Russ.) http://cr.rosminzdrav.ru/#!/recomend/1016.

10. Zhuravleva MV, Zyryanov SK, Paleev FN, et al. Effects of ticagrelor in patients with acute coronary syndrome on the targets of the national cardiovascular program. Russian Journal of Cardiology. 2020;25(5):3931. (In Russ.) doi:10.15829/1560-4071-2020-3931.

11. Valgimigli M, Bueno H, Byrne RA. et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213-260. doi:10.1093/eurheartj/ehx419.

12. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045-57. doi:10.1056/NEJMoa0904327.

13. The Ministry of health of the Russian Federation, the Department of monitoring, analysis and strategic development of health “Central scientific-research Institute of organization and Informatization of health” Ministry of health of Russia. Morbidity of the adult population of Russia in 2018 with a diagnosis established for the first time in life. Statistical data. Part III. Moscow. 2019. (In Russ.) http://www.demoscope.ru/weekly/2019/0835/biblio05.php.

14. Bradley SM, Hess GP, Stewart P, et al. Implications of the PEGASUS-TIMI 54 trial for US clinical practice. Open Heart. 2017;4:e000580. doi:10.1136/openhrt-2016-000580.

15. Federal state statistics service. (In Russ.) Федеральная служба государственной статистики. https://www.gks.ru/folder/12781. (дата обращения: 01.09.2020).

16. Bonaca MP, Storey RF, Theroux P, et al. Efficacy and Safety of Ticagrelor Over Time in Patients With Prior MI in PEGASUS-TIMI 54. J Am Coll Cardiol. 2017;70(11):1368-75. doi:10.1016/j.jacc.2017.07.768.

17. Fleurence RL, Hollenbeak CS. Rates and probabilities in economic modelling: transformation, translation and appropriate application. Pharmacoeconomics. 2007;25(1):3-6. doi:10.2165/00019053-200725010-00002.