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Aspirin Combined With Ticagrelor or Clopidogrel in STEMI Patients With Diabetes Mellitus and Poor Glycemic Control

Yan Liu1,2, Xue Liu1, Dongyuan Sun1

  • 1Department of Cardiology, National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|February 9, 2026
PubMed

Insights

Ticagrelor significantly reduced major adverse cardiovascular events and cardiac death in ST-segment elevation myocardial infarction patients with diabetes and poor glycemic control. This dual antiplatelet therapy showed comparable bleeding risk to clopidogrel.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Pharmacology

Background:

  • Safety and efficacy of dual antiplatelet therapy (DAPT) with ticagrelor or clopidogrel in ST-segment elevation myocardial infarction (STEMI) patients with diabetes mellitus (DM) and poor glycemic control remain unclear.
  • Understanding optimal antithrombotic strategies is crucial for this high-risk patient population undergoing primary percutaneous coronary intervention (pPCI).

Purpose of the Study:

  • To compare the efficacy and safety of ticagrelor versus clopidogrel-based DAPT in STEMI patients with DM and poor glycemic control undergoing pPCI.
  • To assess risks of major adverse cardiovascular events (MACCE), bleeding events, and net adverse clinical events (NACE).

Main Methods:

  • Retrospective analysis of 2732 STEMI patients with DM and poor glycemic control from the CCC-ACS program (Nov 2014 - Dec 2019).
  • Propensity score matching (PSM) and Cox proportional hazards regression were used for comparative analysis.
  • Primary endpoints included in-hospital MACCE, TIMI bleeding events, and NACE.

Main Results:

  • After PSM, the ticagrelor group showed significantly lower in-hospital MACCE (HR=0.545, p=0.025), cardiac death (HR=0.380, p=0.043), and NACE (HR=0.728, p=0.018) compared to the clopidogrel group.
  • No significant difference in TIMI bleeding events was observed between the ticagrelor and clopidogrel groups (p>0.05).

Conclusions:

  • Ticagrelor-based DAPT is associated with reduced MACCE and NACE in STEMI patients with DM and poor glycemic control undergoing pPCI.
  • Ticagrelor use did not increase bleeding risk compared to clopidogrel in this high-risk cohort.
Abstract

Keywords:
ST‐segment elevation myocardial infarctionclopidogreldiabetes mellitusglycated hemoglobin A1chyperglycemiaticagrelor

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