Ninety-Day Readmission and Long-Term Mortality in Medicare Patients (≥65 Years) Treated With Ticagrelor Versus Prasugrel After Percutaneous Coronary Intervention (from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium)
Section snippets
Methods
We performed a retrospective analysis on data collected by the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2), a registry of all patients who underwent PCI in the state of Michigan. This is a prospective, multicenter, statewide registry of patients who underwent PCI at any nonfederal hospital in Michigan. A more detailed description of the registry, including data collection and auditing practices, has been described previously.9, 10 For the present study, we evaluated
Results
From January 1, 2013, to December 31, 2014, a total of 13,702 Medicare patients who underwent PCI were discharged alive on clopidogrel, ticagrelor, or prasugrel at 47 hospitals in Michigan. Of these patients, 10,261 were discharged on clopidogrel and were excluded. After further exclusions including those aged <65 years old, there were 1,243 patients in the ticagrelor group and 1,014 patients in the prasugrel group (Figure 1). Baseline characteristics of the unmatched and matched cohorts are
Discussion
In this retrospective observational study examining patients discharged on ticagrelor or prasugrel after undergoing PCI for ACS, we found no significant differences in the rates of 90-day readmission and 1-year mortality among matched patients. After excluding patients with absolute or relative contraindications to prasugrel in a sensitivity analysis, we found no significant differences in the rates of readmission or mortality.
There is reason to believe that there may be important differences
Acknowledgment
The authors are indebted to all the study coordinators, investigators, and patients who participated in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry.
Disclosures
Hitinder S. Gurm receives research funding from Blue Cross Blue Shield of Michigan and the National Institutes of Health and is a consultant for Osprey Medical. None of the authors have any conflicts directly relevant to this study.
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Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis
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2020, Cardiovascular Revascularization MedicineCitation Excerpt :The change based on the proposal of the Bundle Payment for Care Improvement Initiative could have substantial financial impact there could be potentially more readmissions with financial penalties. We found only one study of 90-day readmissions which took place in a Medicare cohort [40] and further work on 90-day readmissions is needed. In conclusion, readmissions after PCI are an important problem in contemporary PCI.
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2018, International Journal of CardiologyCitation Excerpt :In order to minimize that ticagrelor was not assigned after a randomization phase we obtained a subset of paired patients, by propensity score matching, to perform the last analyses that aimed to assess the effect of ticagrelor on patients with prasugrel contraindication. This methodology has been largely described and it equates group characteristics using defined variables in order to analyze the effect of a single variable or treatment [25, 26]. Prasugrel and ticagrelor were firstly used in 2010 in both centers and, therefore, for this analysis only patients admitted between 2010 and 2016 were included, what resulted in a subset of 3816 patients.
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Authorship declaration: All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors, and all authors agree with the manuscript.
Chris Song and Devraj Sukul contributed equally to the drafting and preparation of the manuscript. Hitinder Gurm and Milan Seth had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Dr. Sukul is supported by the National Institutes of Health T32 postdoctoral research training grant (T32-HL007853) Bethesda, Maryland. This work was supported by the Blue Cross Blue Shield of Michigan and Blue Care Network as part of the Blue Cross Blue Shield of Michigan Value Partnerships program. The funding source supported data collection at each site and funded the data-coordinating center but had no role in study concept, interpretation of findings, or in the preparation, final approval, or decision to submit the manuscript.
Disclaimer: Although Blue Cross Blue Shield of Michigan (BCBSM) and BMC2 work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees.
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