Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction: experiences from...

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Ticagrelor is a P2Y12 inhibitor shown to reduce ischemic events in acute coronary syndrome (ACS) compared to clopidogrel.
• Real-world data on the comparative effectiveness and safety of ticagrelor versus clopidogrel post-ACS is valuable for clinical decision-making.

Purpose of the Study:

• To evaluate the clinical outcomes of ticagrelor compared to clopidogrel in a large, real-world population of patients following ACS.
• To assess the risks of major adverse cardiovascular events and bleeding associated with each antiplatelet therapy.

Main Methods:

• A prospective cohort study involving 45,073 ACS patients discharged on either ticagrelor or clopidogrel between 2010 and 2013.
• Primary outcome: composite of all-cause death, re-admission with myocardial infarction (MI), or stroke.
• Secondary outcomes: individual components of the primary outcome and re-admission with bleeding.

Main Results:

• Ticagrelor use was associated with a significantly lower risk of the primary composite outcome (11.7% vs. 22.3%; adjusted HR 0.85) and all-cause death (5.8% vs. 12.9%; adjusted HR 0.83) at 24 months.
• The risk of MI was similar between groups (6.1% vs. 10.8%; adjusted HR 0.89).
• Re-admission with bleeding was higher with ticagrelor (5.5% vs. 5.2%; adjusted HR 1.20), as was PCI-related in-hospital bleeding (3.7% vs. 2.7%; adjusted OR 1.57).

Conclusions:

• In a real-world setting, ticagrelor use post-ACS is associated with reduced risks of death, MI, or stroke and death alone compared to clopidogrel.
• Ticagrelor is linked to an increased risk of bleeding events, including PCI-related bleeding.
• These findings align with results from randomized controlled trials, supporting the observed efficacy and safety profiles.