Ticagrelor versus Clopidogrel in Patients with left main Coronary Artery Stenting
Yufeng Yan1, Haimei Xu1, Yingying Zhao1
1Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China.
Insights
Ticagrelor significantly reduced all-cause mortality and stent thrombosis in left main coronary artery stenting patients compared to clopidogrel. This study found no increased risk of major bleeding with ticagrelor, suggesting its viability.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Left main (LM) coronary artery disease presents unique anatomical challenges and risks.
- Optimal antiplatelet therapy post-stenting in LM disease remains a subject of debate.
Purpose of the Study:
- To compare the efficacy and safety of ticagrelor versus clopidogrel in patients undergoing stent implantation for LM coronary artery disease.
Main Methods:
- A retrospective analysis of 3221 patients with LM coronary artery stenting.
- Propensity score matching was used to balance baseline characteristics between the ticagrelor (n=1550) and clopidogrel (n=1671) groups.
- Primary endpoint: all-cause mortality. Secondary endpoints: cardiovascular death, myocardial infarction, stroke, stent thrombosis, target vessel revascularization, and major bleeding (BARC 3, 5).
Main Results:
- After matching (n=1228 per group), ticagrelor showed significantly lower three-year all-cause mortality (5.7% vs. 8.5%; P=0.040).
- Ticagrelor use was associated with reduced target lesion revascularization (3.3% vs. 6.4%; P=0.001) and stent thrombosis (1.6% vs. 3.7%; P=0.004).
- No significant difference in major bleeding events was observed between the ticagrelor and clopidogrel groups.
Conclusions:
- Ticagrelor demonstrates superior efficacy in reducing all-cause mortality, target lesion revascularization, and stent thrombosis compared to clopidogrel in LM stenting.
- Ticagrelor is a safe alternative, with no increased risk of major bleeding, making it a viable option for LM disease treatment.
Purpose:
The left main (LM) coronary artery disease poses high risks for its special anatomical characteristics. Optimal antiplatelet therapy is still controversial in this disease. We aimed to investigate the efficacy and safety of ticagrelor and clopidogrel in patients with stent implantation in the LM coronary artery.
Methods:
We analyzed 3221 patients with stent implantation in the LM coronary artery from January 2011 to June 2022. Patients were separated into two groups: the ticagrelor group (n = 1550) and the clopidogrel group (n = 1671). Baseline data were balanced by propensity score matching. The primary endpoint was all-cause mortality, and secondary endpoints included cardiovascular death, myocardial infarction, stroke, stent thrombosis, or target vessel revascularization. The primary safety endpoint was major bleeding, defined as BARC 3, 5 bleeding.
Results:
After propensity score matching (n = 1228 in each group), ticagrelor was linked to a lower incidence of all-cause mortality compared with clopidogrel after a three-year follow-up (5.7% vs. 8.5%; HR:0.728; 95%CI:0.537-0.985, P = 0.040). Ticagrelor treatment reduced target lesion revascularization (3.3% vs. 6.4%; HR: 0.542; 95%CI: 0.371-0.791, P = 0.001) and stent thrombosis (1.6% vs. 3.7%; HR: 0.459; 95%CI: 0.271-0.776, P = 0.004). There was no significant difference in major bleeding between the two groups. Multivariate COX analysis suggested that age, heart rate, diabetes, prior myocardial infarction, hemoglobin, serum creatinine, ticagrelor, DAPT duration, LM true-bifurcation, LM stent diameters, and IVUS were independent predictive parameters of all-cause death.
Conclusions:
Ticagrelor was associated with lower all-cause mortality and no increased risk of major bleeding compared to clopidogrel in LM stenting patients. Thus, ticagrelor can be considered a viable substitute for clopidogrel in LM disease.
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