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Updated: Feb 8, 2026
Acute Myocardial Infarction in Rats
Published on: February 16, 2011
Ischemic stroke rates decrease with increased ticagrelor use after acute myocardial infarction in patients treated
Anders Ulvenstam1,2, Robin Henriksson, Lars Söderström
11 Unit of Research, Education and Development, Östersund Hospital, Sweden.
Insights
The introduction of ticagrelor, a dual antiplatelet therapy, significantly reduced the risk of ischaemic stroke in acute myocardial infarction patients undergoing percutaneous coronary intervention in Sweden. This real-world study found a 21% relative risk reduction after ticagrelor
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) is crucial for acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI).
- Clopidogrel has been the standard DAPT, but newer agents like ticagrelor offer potential benefits.
- The comparative effectiveness of ticagrelor versus clopidogrel in reducing ischaemic stroke risk in real-world AMI patients post-PCI remains unclear.
Purpose of the Study:
- To investigate whether the adoption of ticagrelor-based DAPT, compared to clopidogrel-based DAPT, is associated with a reduced risk of ischaemic stroke.
- To assess the real-world impact of ticagrelor introduction on ischaemic stroke incidence in AMI patients treated with PCI.
Main Methods:
- A real-world cohort study using Swedish national registries (8 Dec 2009–31 Dec 2013).
- Patients with AMI undergoing PCI were divided into two periods: pre-ticagrelor (clopidogrel only) and post-ticagrelor introduction.
- Kaplan-Meier analysis and multivariable Cox proportional hazards models were used to assess ischaemic stroke risk and identify predictors.
Main Results:
- A total of 34,931 patients were analyzed, with 686 ischaemic stroke events within one year.
- The incidence of ischaemic stroke was lower in the post-ticagrelor period (1.8%) compared to the clopidogrel-only period (2.2%), p=0.004.
- Ticagrelor use was associated with a 21% relative risk reduction in ischaemic stroke (HR 0.79, 95% CI 0.68-0.92; p=0.003).
Conclusions:
- The introduction of ticagrelor in Sweden was associated with a significant decrease in the risk of ischaemic stroke among patients with AMI treated with PCI.
- Older age, hypertension, diabetes, atrial fibrillation, heart failure, and prior ischaemic stroke were independent predictors of increased stroke risk.
Abstract:
Aims It is unknown whether dual antiplatelet therapy with ticagrelor instead of clopidogrel reduces the risk of ischaemic stroke in acute myocardial infarction patients that undergo percutaneous coronary intervention. This study investigated whether the introduction of dual antiplatelet therapy with ticagrelor was associated with reduced ischaemic stroke risk in a real-world population. Methods and results Patients with ischaemic stroke after acute myocardial infarction from 8 December 2009-31 December 2013 were identified using the Register for Information and Knowledge on Swedish Heart Intensive Care Admissions and the Swedish National Patient Register. The study period was divided into two similar periods using the date of the first prescription of ticagrelor as the cut-off. The risk of ischaemic stroke in percutaneous coronary intervention-treated acute myocardial infarction patients during the first period (100% clopidogrel treatment) versus the second period (60.7% ticagrelor treatment) was assessed using Kaplan-Meier analysis. Variables associated with ischaemic stroke were identified using a multivariable Cox proportional hazards model. There were 686 ischaemic stroke events (2.0%) among 34931 percutaneous coronary intervention-treated acute myocardial infarction patients within one year, 366 (2.2%) during the first period and 320 (1.8%) during the second period ( p = 0.004). The Cox model showed a 21% relative risk reduction in ischaemic stroke in the second period versus the first one (hazard ratio 0.79, 95% confidence interval, 0.68-0.92; p = 0.003). The independent predictors of increased stroke risk were older age, hypertension, diabetes mellitus, atrial fibrillation, heart failure during hospitalization, previous ischaemic stroke, and ST-segment elevation myocardial infarction. Conclusion The risk of ischaemic stroke in percutaneous coronary intervention-treated acute myocardial infarction patients decreased after the introduction of ticagrelor in Sweden.
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