Ticagrelor versus Clopidogrel in Patients with Severe Renal Insufficiency Undergoing PCI for Acute Coronary Syndrome

Area of Science:

• Cardiology
• Pharmacology
• Nephrology

Background:

• Current guidelines recommend potent antiplatelet agents post-percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).
• Limited data exist on optimal antiplatelet therapy in patients with severe renal insufficiency undergoing PCI.
• This study addresses the efficacy of ticagrelor versus clopidogrel in ACS patients with severe renal insufficiency.

Purpose of the Study:

• To compare the effectiveness of ticagrelor and clopidogrel in patients with ACS and severe renal insufficiency undergoing PCI.
• To evaluate the impact of ticagrelor versus clopidogrel on major adverse cardiovascular events and bleeding risk in this specific patient group.

Main Methods:

• Retrospective enrollment of 276 patients with ACS and severe renal insufficiency (eGFR ≤ 30 mL/min/1.73 m² or on dialysis) who underwent PCI.
• Analysis of 1-year outcomes using adjusted Cox proportional hazards models, including a composite primary endpoint (cardiovascular death, MI recurrence, ischemic stroke), all-cause mortality, and Bleeding Academic Research Consortium (BARC) bleeding events.
• Comparison between patients treated with ticagrelor (n=108) and clopidogrel (n=168).

Main Results:

• No significant difference was observed in the adjusted risk of the primary endpoint (HR, 0.78; P=0.367) or all-cause mortality (HR, 0.86; P=0.708) between ticagrelor and clopidogrel groups.
• The ticagrelor group experienced a significantly higher risk of total bleeding (HR, 3.01; P=0.01) compared to the clopidogrel group.
• Subgroup analyses did not reveal significant heterogeneity in outcomes based on confounders.

Conclusions:

• Ticagrelor did not demonstrate superior efficacy over clopidogrel in reducing major adverse cardiovascular events or all-cause mortality in Chinese patients with ACS and severe renal insufficiency undergoing PCI.
• Ticagrelor use was associated with a significantly increased risk of bleeding in this patient population.
• The findings suggest that clopidogrel may be a safer alternative regarding bleeding risk in ACS patients with severe renal insufficiency undergoing PCI.