Patient Characteristics, Persistence to Treatment and Outcome Events in Patients Treated With Ticagrelor 60 mg After Myocardial Infarction in Real-world Clinical Practice

This observational cohort study will include patients initiating treatment with ticagrelor 60 mg after a myocardial infarction (MI), and describe their patient characteristics and persistence to treatment. To contextualise the characteristics of the ticagrelor patients, two reference cohorts will be created, including patients treated with another P2Y12 inhibitor than ticagrelor (clopidogrel, prasugrel, or ticlopidine), and patients not treated with any P2Y12 inhibitor, within a comparable timepoint from an MI as for the ticagrelor 60 mg patients. If the a priori threshold of 5,000 person-years on treatment with ticagrelor 60 mg is met, to ensure sufficient precision, outcome events (bleeding and cardiovascular events) will also be analysed and described. Outcome events will only be described in the ticagrelor cohorts; no comparison of outcomes will be made between the ticagrelor and the reference cohorts.

The primary outcome is bleeding requiring hospitalisation. The secondary outcomes include components of the primary outcome, and cardiovascular outcomes. Persistence to treatment with ticagrelor 60 mg will also be assessed The study will be performed in the US and 4 European countries (Sweden, United Kingdom, Italy, Germany).

Inclusion criteria

Primary Analysis Population:

• Hospitalisation with a primary diagnosis of MI during the eligibility period
• Ticagrelor cohort: A first prescription of ticagrelor 60 mg after the most recent hospitalisation with a primary diagnosis of MI.
• Non-ticagrelor cohort: A prescription of clopidogrel, prasugrel or ticlopidine, or no prescription for any of these medications, at a comparable timepoint relative to their MI as for the ticagrelor cohort

Secondary Analysis Population:

• The qualifying prescription 12-36 months after a hospitalisation with a primary diagnosis of MI and treatment with an ADP receptor antagonist (clopidogrel, prasugrel, ticagrelor 90 mg, ticlopidine) ≤12 months prior to the qualifying prescription, or the qualifying prescription 12-24 months after a hospitalisation with a primary diagnosis of MI AND
• Age ≥50 years
• At least one of the following risk factors:

• Age ≥ 65 years
• Diabetes mellitus requiring medication
• A second prior MI
• Evidence of multivessel coronary artery disease
• Chronic non-end-stage renal dysfunction

Exclusion criteria

Applicable to the Primary and Seconday Analysis Populations:

• Dies, emigrates, or disenrolls from the database (where applicable) prior to the ticagrelor approval date.
• Ineligibility for ticagrelor use (restricted to the conditions possible to capture within the data sources)-one or more of the following:

• Concomitant use of an anticoagulant
• Prior ischaemic stroke
• Prior history of intracranial bleeding
• Severe hepatic impairment
• Gastrointestinal bleeding
• Renal failure requiring dialysis
• Concomitant use of a strong CYP3A4 inhibitor or inducer
• <1 year of data available prior to the qualifying MI (for assessment of patient characteristics at qualifying MI)