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Ticagrelor Versus Clopidogrel in Patients With ST-Elevation Myocardial Infarction and Elevated Platelet Counts: A
Fang-Jie Ji1,2, Xian Shao3, Tian-Shu Gu1
1Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, 300211 Tianjin, China.
Insights
Ticagrelor significantly improved outcomes for ST-elevation myocardial infarction (STEMI) patients with high platelet counts compared to clopidogrel. This simple platelet count threshold offers a practical guide for P2Y12 inhibitor selection in acute settings.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- Dual antiplatelet therapy is crucial for ST-elevation myocardial infarction (STEMI) management.
- Optimal P2Y12 inhibitor choice in STEMI patients with thrombocytosis remains unclear.
- Elevated platelet counts (thrombocytosis) may influence antiplatelet therapy efficacy.
Purpose of the Study:
- To compare the effectiveness of ticagrelor versus clopidogrel in STEMI patients with elevated platelet counts (≥350 × 109/L).
- To evaluate the impact of P2Y12 inhibitor choice on major adverse cardiac and cerebrovascular events (MACCEs) and other clinical outcomes.
Main Methods:
- Retrospective cohort study using the Tianjin Health and Medical Big Data platform (2010-2023).
- Propensity score matching of 461 STEMI patients into ticagrelor and clopidogrel groups.
- Kaplan-Meier curves and Cox regression analyses to assess outcomes, including MACCEs, NACEs, mortality, and bleeding events (BARC types 3-5).
Main Results:
- Ticagrelor significantly reduced MACCEs (6.9% vs. 12.1%, p=0.008) and all-cause mortality (3.9% vs. 9.5%, p<0.001) compared to clopidogrel.
- Ticagrelor was independently associated with lower risks of MACCEs (aHR=0.59), NACEs (aHR=0.64), and all-cause mortality (aHR=0.47).
- Secondary outcomes like cardiac mortality and NACEs were also significantly lower with ticagrelor.
Conclusions:
- Ticagrelor demonstrates superior clinical outcomes in STEMI patients with elevated platelet counts compared to clopidogrel.
- A simple platelet count threshold (≥350 × 109/L) serves as a practical biomarker for selecting potent P2Y12 inhibition.
- This approach is more immediate and practical than costly, time-consuming genetic testing in acute settings.
Background:
Dual antiplatelet therapy is essential for managing ST-elevation myocardial infarction (STEMI); however, the optimal choice of P2Y12 inhibitor in patients with thrombocytosis remains unclear. Therefore, this study aimed to compare the effects of clopidogrel and ticagrelor on the prognosis of patients with STEMI and platelet counts exceeding 350 × 109/L.
Methods:
Utilizing data from the Tianjin Health and Medical Big Data platform (2010-2023), this retrospective cohort study included patients with acute myocardial infarction from 82 hospitals. After propensity score matching, 461 patients were assigned to two groups: ticagrelor and clopidogrel. Kaplan-Meier curves and Cox regression analyses were employed to evaluate outcomes, with major adverse cardiac and cerebrovascular events (MACCEs) as the primary outcome. Secondary outcomes included net adverse clinical events (NACEs), all-cause mortality, cardiac mortality, recurrent non-fatal myocardial infarction, coronary revascularization, cerebral infarction, and bleeding events (Bleeding Academic Research Consortium (BARC) types 3-5). A MACCE was defined as a composite of cardiac mortality, recurrent non-fatal myocardial infarction, and cerebral infarction, while a NACE encompassed a MACCE plus bleeding events (BARC types 3-5).
Results:
Ticagrelor significantly reduced MACCEs (6.9% versus 12.1%; p = 0.008), all-cause mortality (3.9% versus 9.5%; p < 0.001), cardiac mortality (3.5% versus 7.4%; p = 0.0096), and NACEs (8.2% versus 13.0%; p = 0.021) compared with clopidogrel. Exploratory multivariable analysis confirmed an independent association of ticagrelor with reduced risks of MACCEs (adjusted hazard ratio (aHR) = 0.59; 95% confidence interval (CI), 0.37-0.93), NACEs (aHR = 0.64; 95% CI, 0.42-0.98), and all-cause mortality (aHR = 0.47; 95% CI, 0.26-0.83).
Conclusions:
Ticagrelor was associated with superior clinical outcomes in patients with STEMI and elevated admission platelet counts (≥350 × 109/L) compared with clopidogrel. In contrast to genetic testing, which is costly, time-consuming (≥24-72 hours), and impractical in emergencies, this simple, universally available platelet count threshold offers an immediate, practical biomarker for selecting potent P2Y12 inhibition in acute settings.
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