Background. The two newer oral P2Y12 inhibitors prasugrel and ticagrelor have proven superior to clopidogrel in the treatment of acute coronary syndrome (ACS). The extent to which the reduction in mortality seen with ticagrelor is confined to this particular agent is hard to judge by simply looking at the overall study results as the study populations were composed of different cohorts at substantially different risk of death. Method.s A meta-regression technique was applied to 12 distinctive patient cohorts, six for each of prasugrel and ticagrelor, to investigate differential effects on mortality of P2Y12 inhibitors. Results. Data for the analysis cohorts, totalling 37,372 patients, were extracted from publications and cover a widely comparable spectrum of patient types, defined by the type of ACS and treatment strategy. The meta-regression lines for cardiovascular mortality with prasugrel or ticagrelor (each versus clopidogrel), as well as for both agents pooled, indicate a linear relationship with increasing benefit seen with higher underlying risk (p = 0.007, 0.021 and 0.003, and R2 = 0.87, 0.77 and 0.62, respectively). Conclusions. In the ACS patients studied, we found a mortality benefit with the two newer oral P2Y12 inhibitors prasugrel and ticagrelor when compared with clopidogrel, which increases progressively as the underlying risk of death increases. This appears to be a class effect for these two newer agents.

Cardiocenter 3rd Medical Faculty of Charles University and University Hospital Kralovske Vinohrady Šrobárova 50 100 34 Prague 10 Czech Republic

Department for Internal Medicine and Cardiology Clinic Klagenfurt at Wörthersee Feschingstrasse 11 9020 Klagenfurt am Wőrthersee Austria

Department of Cardiology C5 P Leiden University Medical Center PO Box 9600 2300 RC Leiden The Netherlands

Karl Landsteiner Institute for Interdisciplinary Science Reha Zentrum Münster in Tirol 6232 Münster Austria

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