Ticagrelor vs. clopidogrel in non-ST-elevation acute coronary syndromes
1Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University, No. 324, Jingwu Road, Jinan, China.
Insights
Ticagrelor therapy in non-ST-segment elevation myocardial infarction (NSTEMI) patients after percutaneous coronary intervention (PCI) can lead to a significant decrease in heart rate at 12 months. This heart rate reduction was associated with a lower risk of major adverse cardiovascular events.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Non-ST-segment elevation myocardial infarction (NSTEMI) management often involves dual antiplatelet therapy.
- Ticagrelor and clopidogrel are commonly used P2Y12 inhibitors.
- Bradyarrhythmic events are a potential concern with antiplatelet therapies.
Purpose of the Study:
- To evaluate bradyarrhythmic events in NSTEMI patients treated with ticagrelor versus clopidogrel after percutaneous coronary intervention (PCI).
- To assess the impact of ticagrelor combination therapy on heart rate and major adverse cardiovascular events (MACE).
Main Methods:
- A randomized study of 300 NSTEMI patients undergoing PCI.
- Patients were assigned to either ticagrelor (n=149) or clopidogrel (n=151) therapy.
- Follow-up included ECG and 24-h Holter monitoring at 1, 6, and 12 months post-PCI.
Main Results:
- At 12 months, 53.3% of patients on ticagrelor experienced a heart rate decrease compared to 24.7% on clopidogrel (p<0.05).
- This difference was not significant at 1 or 6 months.
- Ticagrelor-associated heart rate reduction was independently linked to a lower risk of MACE.
Conclusions:
- Ticagrelor can lower resting heart rate and potentially cause bradyarrhythmias by the 12-month mark post-PCI.
- The heart rate reduction observed with ticagrelor was associated with improved cardiovascular outcomes.
Aim:
The aim of this study was to evaluate the bradyarrhythmic events associated with ticagrelor combination therapy in the management of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI).
Patients And Methods:
The study comprised 300 patients with NSTEMI who were treated via percutaneous coronary intervention (PCI). Patients were randomly assigned to two groups: the clopidogrel group (initial dose of 300 mg and then maintenance dose of 75 mg once daily, n = 151) and the ticagrelor group (initial dose of 180 mg and then maintenance dose of 90 mg twice daily, n = 149). All patients were followed up in the outpatient clinic. Follow-up included 12-lead electrocardiography and 24-h Holter monitoring performed 1, 6, and 12 months after the revascularization procedure.
Results:
Of the 300 patients, 112 patients (36.7 %) had a decrease in heart rate at the 12-month follow-up. Of these, 80 patients were in the ticagrelor group (53.3 %) vs. 32 patients in the clopidogrel group (24.7 %; p < 0.05). However, the difference was not statistically significant at the 1-month and 6-month follow-up visits. After adjusting for potential confounders, the reduction in heart rate with ticagrelor combination therapy remained independently associated with a reduced risk of major adverse cardiovascular events (hazard ratio, 2.1; 95 % CI, 1.90-2.23), while ticagrelor therapy reduced the risk to a level equivalent to that of patients in the clopidogrel group.
Conclusion:
Ticagrelor can lower the resting heart rate of patients and cause bradyarrhythmias in the 12th month after PCI.
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