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Ticagrelor versus clopidogrel in patients with acute coronary syndrome undergoing complex percutaneous coronary
Yuzhuo Li1,2, Jing Li2, Miaohan Qiu2
1Postgraduate Training Base of The General Hospital of Northern Theater Command, Jinzhou Medical University, Jinzhou, Liaoning, China.
Insights
Ticagrelor significantly reduced ischemic events compared to clopidogrel in acute coronary syndrome (ACS) patients undergoing complex percutaneous coronary intervention (PCI). Bleeding risk was similar between ticagrelor and clopidogrel, indicating improved net clinical benefit with ticagrelor.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Effectiveness of ticagrelor versus clopidogrel in acute coronary syndrome (ACS) patients undergoing complex percutaneous coronary intervention (PCI) remains unclear in real-world settings.
- Complex PCI involves challenging lesions like bifurcations, chronic total occlusions, and restenosis, requiring robust antiplatelet therapy.
Purpose of the Study:
- To compare the long-term effectiveness and safety of ticagrelor and clopidogrel in ACS patients undergoing complex PCI.
- To evaluate ischemic and bleeding outcomes in a real-world, all-comers PCI registry.
Main Methods:
- Retrospective analysis of an all-comers PCI registry.
- Comparison of dual antiplatelet therapy with ticagrelor versus clopidogrel in ACS patients with complex PCI.
- Propensity score matching (PSM) to minimize confounding factors.
- Primary endpoint: composite of cardiac death, myocardial infarction, or stroke.
- Safety endpoint: Bleeding Academic Research Consortium (BARC) types 2, 3, and 5 bleeding.
Main Results:
- Ticagrelor was used in 35.2% and clopidogrel in 64.8% of ACS patients undergoing complex PCI.
- After PSM, ticagrelor was associated with significantly lower rates of composite ischemic events (1.50% vs. 2.65%) and all-cause death (1.09% vs. 1.81%) compared to clopidogrel.
- No significant difference in major bleeding events (BARC types 2, 3, and 5) was observed between the two groups.
Conclusions:
- Ticagrelor demonstrates superior effectiveness in reducing ischemic events compared to clopidogrel in ACS patients undergoing complex PCI.
- The safety profile regarding major bleeding is comparable between ticagrelor and clopidogrel.
- Ticagrelor offers a potential advantage in managing ACS patients with complex coronary interventions.
Objectives:
To evaluate the effectiveness and safety of ticagrelor versus clopidogrel in patients with acute coronary syndromes (ACS) undergoing complex percutaneous coronary intervention (PCI).
Background:
It remains inconclusive whether ticagrelor is superior to clopidogrel in ACS patients undergoing complex PCI in real-world practice.
Methods:
Based on an all-comers PCI registry, we compared the long-term effectiveness and safety between ticagrelor and clopidogrel in ACS patients undergoing complex PCI, defined as PCI procedures for complex lesions including bifurcation, chronic total occlusion, ostial, tortuous, calcific, diffused, thrombus-containing, and restenotic lesions. The primary ischemic outcome was a composite of cardiac death, myocardial infarction, or stroke. The safety outcome comprised Bleeding Academic Research Consortium (BARC) types 2, 3, and 5 bleeding. Propensity score matching (PSM) was performed to reduce bias.
Results:
Among ACS patients who underwent complex PCI, 4373 (35.2%) and 8065 (64.8%) received dual antiplatelet therapy based on ticagrelor and clopidogrel, respectively. The incidences of composite ischemic events (before PSM: 1.74% vs. 2.84%; after PSM: 1.50% vs. 2.65%; p < 0.01 for both) and all-cause death (before PSM: 1.23% vs. 2.12%, p < 0.01; after PSM: 1.09% vs. 1.81%, p = 0.02) were significantly lower in the ticagrelor-treated than in the clopidogrel-treated group. There was no significant difference in BARC types 2, 3, and 5 bleeding between groups.
Conclusions:
Whilst the risk of major bleeding was comparable between the two drugs, ticagrelor was associated with a significantly lower risk of ischemic events than clopidogrel in ACS patients undergoing complex PCI.
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