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Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
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Outcomes in patients treated with ticagrelor versus clopidogrel after acute myocardial infarction stratified by renal

Robert Edfors1,2, Anders Sahlén1,2,3, Karolina Szummer1,2

  • 1Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.

Heart (British Cardiac Society)
|March 26, 2018
PubMed

Insights

Ticagrelor use in acute myocardial infarction (MI) patients showed a lower risk of death, MI, or stroke compared to clopidogrel across all estimated glomerular filtration rate (eGFR) levels. However, ticagrelor was associated with increased bleeding risk, particularly in patients with reduced eGFR.

Area of Science:

  • Cardiology
  • Pharmacology
  • Nephrology

Background:

  • Acute myocardial infarction (MI) management often involves P2Y12 inhibitors like ticagrelor and clopidogrel.
  • Patient outcomes may vary based on renal function, specifically estimated glomerular filtration rate (eGFR).

Purpose of the Study:

  • To analyze the comparative effectiveness and safety of ticagrelor versus clopidogrel in acute MI survivors.
  • To stratify outcomes based on patient estimated glomerular filtration rate (eGFR) levels.

Main Methods:

  • Utilized data from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease registry.
  • Employed adjusted Cox proportional hazards models to assess the association between ticagrelor and clopidogrel with composite outcomes (death, MI, stroke) and bleeding rehospitalization at one year.
  • Stratified analyses were performed across eGFR categories: >60, 30-60, and <30 mL/min/1.73m².

Main Results:

  • In a cohort of 45,206 MI patients, ticagrelor was associated with a lower adjusted 1-year risk of death, MI, or stroke compared to clopidogrel across all eGFR strata (eGFR>60: HR 0.87; eGFR 30-60: HR 0.82).
  • Ticagrelor use was linked to a higher risk of bleeding rehospitalization, with a more pronounced effect observed in patients with eGFR <30 mL/min/1.73m² (HR 1.79).
  • No significant interaction was found between treatment and eGFR for either the composite outcome or bleeding risk.

Conclusions:

  • Ticagrelor demonstrates a reduced risk of major adverse cardiovascular events compared to clopidogrel in acute MI patients, irrespective of renal function.
  • Clinicians should exercise caution regarding increased bleeding risk with ticagrelor, especially in patients with severely impaired renal function (eGFR <30 mL/min/1.73m²).
  • The findings support individualized treatment decisions considering both efficacy and bleeding risk in MI patients with varying degrees of renal impairment.
Abstract

Keywords:
acute coronary syndromesacute myocardial infarctioncoronary artery diseaseepidemiology

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