Contemporary Use of Ticagrelor in Interventional Practice (from Blue Cross Blue Shield of Michigan Cardiovascular Consortium)

Ticagrelor has greater antiplatelet activity than clopidogrel and is approved for use in patients with acute coronary syndrome (ACS). There are limited data on use of ticagrelor in real-world practice. We assessed ticagrelor use in 64,600 patients who underwent percutaneous coronary intervention from January 2012 to March 2014 at 47 Michigan hospitals in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Preprocedural risk of major adverse events was estimated with Blue Cross Blue Shield of Michigan Cardiovascular Consortium risk prediction models. The proportion of patients receiving clopidogrel, prasugrel, and ticagrelor was 72% (n = 46,864), 20% (n = 12,596), and 8% (n = 5,140), respectively, using ticagrelor increasing over time. Ticagrelor was used at 45 hospitals, ranging from 0.5% to 64.9% of discharges. Patients receiving ticagrelor were older (63.6 vs 59.4), more often women (32.9% vs 26.7%), and were more likely to present with ST-segment elevation myocardial infarction (24.4% vs 18.8%), cardiogenic shock within 24 hours (1.3% vs 0.9%), and anginal class IV (47.8% vs 43.0%) (p <0.05). Compared with prasugrel, ticagrelor was prescribed in patients with a higher predicted risk of percutaneous coronary intervention complications: contrast nephropathy (2.5% vs 1.6%), transfusion (2.2% vs 1.4%), and death (1.2% vs 0.7%) (p <0.001); >10% of patients were given prasugrel or ticagrelor for a non-ACS indication. Ticagrelor is prescribed to a higher risk population, and 1 in 10 patients prescribed ticagrelor or prasugrel did not have ACS.