Health-related quality of life outcomes with prasugrel among medically managed non-ST-segment elevation acute coronary syndrome patients: Insights from the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial

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• 作者：Padma Kaul ; PhD^a ; ^{pkaul@ualberta.ca" class="auth_mail" title="E-mail the corresponding author} ; E. Magnus Ohman ; MD^b ; ^c ; J. David Knight ; MS^c ; Kevin J. Anstrom ; PhD^c ; Matthew T. Roe ; MD ; MHS^b ; ^c ; William E. Boden ; MD^d ; Judith S. Hochman ; MD^e ; Vladimir Ga&scaron ; parović ; MD^f ; Paul W. Armstrong ; MD^a ; ^g ; Patrick McCollam ; PharmD^h ; ⁱ ; Walid Fakhouri ; PhD^h ; ⁱ ; Patricia Cowper ; PhD^c ; Linda Davidson-Ray ; MA^c ; Nancy Clapp-Channing ; MPH^c ; ^m ; Harvey D. White ; MB ; ChB ; DSc^j ; Keith A.A. Fox ; MB ; ChB^k ; Dorairaj Prabhakaran ; MD ; DM ; MSc^l ; Daniel B. Mark ; MD ; MPH^b ; ^c ; for the TRILOGY ACS Investigators
• 刊名：American Heart Journal
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：178
• 期：Complete
• 页码：55-64
• 全文大小：393 K

文摘

Few studies have assessed treatment effects on health-related quality of life (HRQoL) in patients with acute coronary syndrome (ACS) treated without revascularization. The TRILOGY ACS trial randomized patients with ACS to either prasugrel or clopidogrel therapy plus aspirin. Outcomes showed a complex pattern suggestive of late benefits with respect to repeat clinical events and benefits confined to patients who underwent angiography. Here, we examine the HRQoL correlates of these patterns.

Methods

HRQoL was measured at baseline and 3, 12, and 24 months or end of study (EOS) in 7243 patients aged <75 years using the EuroQol 3-level, group 5-dimension index (EQ-5D). Linear mixed effects models for repeated measures were used to examine treatment differences in HRQoL overall, stratified by angiography status, and among patients who did and did not have non-fatal events.

Results

No baseline differences in HRQoL were seen between patients randomized to prasugrel (n = 3620) or clopidogrel (n = 3623). At 24 months, remaining patients assigned to prasugrel (n = 1450) vs. clopidogrel (n = 1443) had higher EQ-5D index scores (86.4 vs. 84.9, P = .01). Mixed effects models found no difference in EQ-5D scores among prasugrel and clopidogrel patients overall across subgroups stratified by angiography status. However, among patients with non-fatal clinical events, patients on clopidogrel reported a larger decrement in HRQoL than patients on prasugrel (79.5 ± 18.1 vs. 80.6 ± 18.0; P = .02).

Conclusions

Overall, there was no difference in HRQoL outcomes among patients receiving prasugrel vs. clopidogrel. However, the differential effects of the treatments among patients with non-fatal events require further investigation.