Related Experiment Video
Updated: Jan 19, 2026
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Efficacy and Safety of Ticagrelor in Comparison to Clopidogrel in Elderly Patients With ST-Segment-Elevation
Johannes Schmucker1, Andreas Fach1, Luis Alberto Mata Marin1
1Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany.
Insights
For elderly patients with ST-segment-elevation myocardial infarction (STEMI), ticagrelor significantly reduced major adverse cardiac and cerebrovascular events compared to clopidogrel. This benefit was observed without an increase in bleeding events within one year.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Current guidelines recommend ticagrelor for ST-segment-elevation myocardial infarction (STEMI).
- Elderly patients (≥75 years) represent a vulnerable population with STEMI.
- Real-world data on ticagrelor's efficacy and safety in this demographic is crucial.
Purpose of the Study:
- To assess the efficacy and safety of ticagrelor versus clopidogrel in elderly patients (≥75 years) with STEMI.
- To evaluate the benefit-risk ratio of ticagrelor in this specific patient group.
- To analyze outcomes in a real-world, all-comers STEMI registry.
Main Methods:
- Analysis of patients aged ≥75 years with STEMI from the Bremen STEMI Registry (2006-2017).
- Comparison of ticagrelor versus clopidogrel treatment groups.
- Primary efficacy outcome: composite of death, myocardial reinfarction, and stroke.
- Safety outcome: significant bleeding events within 1 year.
- Propensity score-matched analysis to adjust for confounders.
Main Results:
- Ticagrelor was associated with a lower rate of major adverse cardiac and cerebrovascular events (25.5% vs. 32.4%, P=0.015) compared to clopidogrel.
- One-year mortality was also lower with ticagrelor (21.1% vs. 26.8%, P=0.035).
- No significant difference in bleeding events was observed between the two groups (5.1% vs. 4.9%).
- Net adverse clinical events were significantly lower for ticagrelor (30.6% vs. 37.3%, P=0.028).
- Propensity score-matched analysis confirmed the benefit of ticagrelor on major adverse cardiac and cerebrovascular events (HR, 0.69; P=0.03).
Conclusions:
- Ticagrelor demonstrates superior efficacy in reducing major adverse cardiac and cerebrovascular events in elderly STEMI patients compared to clopidogrel.
- The observed efficacy benefit of ticagrelor is achieved without a significant increase in bleeding risk.
- These findings support the use of ticagrelor in elderly patients with STEMI based on real-world registry data.
Abstract:
Background Current guidelines recommend the new-generation P2Y12-inhibitor ticagrelor for patients with acute ST-segment-elevation myocardial infarctions (STEMIs). The aim of the present study was to assess efficacy and safety of ticagrelor for elderly patients with STEMI (≥75 years) in an all-comers STEMI registry. Methods and Results Patients with STEMI, aged ≥75 years, treated with primary percutaneous coronary intervention and documented in the Bremen STEMI Registry between 2006 and 2017 entered analysis. The primary efficacy outcome, major adverse cardiac and cerebrovascular events, was defined as a composite of death, myocardial reinfarction, and stroke. The safety outcome was defined as any significant bleeding event within 1 year. To estimate benefit/risk ratio, net adverse clinical events (major adverse cardiac and cerebrovascular events+bleedings) were calculated. Outcomes were estimated in propensity score-matched cohorts to adjust for possible confounders. Of a total of 7466 patients with STEMI, 1087, aged ≥75 years, were selected, of which 552 (51%) received clopidogrel and 535 (49%) received ticagrelor, with similar age (80.9±4.6 versus 80.9±4.6 years) and sex (51% versus 50% female) distributions between treatment arms. The primary efficacy outcome occurred in 32.4% of patients treated with clopidogrel versus 25.5% treated with ticagrelor (P=0.015), with the 1-year mortality rate at 26.8% versus 21.1% (P=0.035). Because there was no difference in the safety outcome (clopidogrel versus ticagrelor, 4.9% versus 5.1%; not significant), net adverse clinical events were higher for clopidogrel than for ticagrelor: 37.3% versus 30.6% (P=0.028). In a propensity score-matched model, the advantage for ticagrelor on major adverse cardiac and cerebrovascular events remained significant (hazard ratio, 0.69; 95% CI, 0.49-0.97; P=0.03), whereas 1-year-mortality (hazard ratio, 0.89; 95% CI, 0.67-1.27; P=0.5) and 1-year bleeding events (hazard ratio, 1.1; 95% CI, 0.4-2.3; P=0.8) did not differ. Conclusions These results from propensity score-matched registry data show that for elderly patients with STEMI, ticagrelor compared with clopidogrel was associated with a reduction in major adverse cardiac and cerebrovascular events without a significant increase in bleeding events within 1 year.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
01:15Drug Dosing: Geriatric Patients
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:22Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion