Comparison of In-Hospital Major Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction Treated...

Area of Science:

• Cardiology
• Pharmacology
• Emergency Medicine

Background:

• Dual antiplatelet therapy (DAPT) is standard for acute myocardial infarction (AMI).
• The comparative efficacy of ticagrelor versus clopidogrel in the emergency department (ED) before percutaneous coronary intervention (PCI) is not well-established.
• This study investigates in-hospital major adverse cardiovascular event (MACE) rates between ticagrelor and clopidogrel in AMI patients treated in the ED prior to PCI.

Purpose of the Study:

• To compare the in-hospital MACE rates between ticagrelor and clopidogrel in patients with AMI receiving DAPT in the ED before PCI.
• To evaluate the association of ticagrelor with reduced risk of MACE compared to clopidogrel.

Main Methods:

• Retrospective analysis of AMI patients receiving DAPT (aspirin plus ticagrelor or clopidogrel) in the ED before PCI.
• Primary outcome: in-hospital MACE rate.
• Secondary outcomes: ED return within 72 hours, 14-day readmission, and revascularization.

Main Results:

• Ticagrelor group showed significantly lower in-hospital MACE rates (3.01% vs. 7.51%, p < 0.001) and mortality (2.15% vs. 5.70%, p < 0.001) compared to clopidogrel.
• Multivariate analysis indicated ticagrelor was independently associated with lower MACE risk (OR: 0.53, 95% CI: 0.32-0.88, p = 0.013).
• Propensity score matching confirmed significantly lower MACE risk in the ticagrelor group (OR 0.42, 95% CI: 0.21-0.85, p = 0.016).

Conclusions:

• DAPT with ticagrelor and aspirin in the ED before PCI is linked to reduced in-hospital MACE rates in AMI patients.
• Ticagrelor demonstrates superior efficacy over clopidogrel in preventing early MACE in this patient population.
• Early administration of ticagrelor in the ED setting may be a beneficial strategy for managing AMI patients undergoing PCI.