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Initial Antiplatelet Strategy and 1-Year Outcomes in East Asian Patients With Acute Myocardial Infarction and Renal
Seok Oh1, Kyung Hoon Cho1,2, Min Chul Kim1,2
1Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Insights
In Korean patients with acute myocardial infarction and renal impairment (AMI-RI), initial ticagrelor and clopidogrel showed similar effectiveness and safety. However, many ticagrelor users switched therapy, making results inconclusive.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- Optimal P2Y12 inhibitor choice for acute myocardial infarction with renal impairment (AMI-RI) is uncertain, especially in East Asian populations.
- Real-world data on ticagrelor vs. clopidogrel in this specific patient group is limited.
Purpose of the Study:
- To compare the real-world effectiveness and safety of initial ticagrelor versus clopidogrel therapy.
- To evaluate outcomes in Korean patients with AMI-RI.
Main Methods:
- Analysis of 7,590 Korean patients with AMI-RI (eGFR <90 mL/min/1.73 m²).
- Comparison of initial ticagrelor (3,793 patients) versus clopidogrel (3,797 patients).
- Propensity score matching (PSM) used to adjust for baseline differences; primary endpoints were major adverse cardiac and cerebrovascular events (MACCEs) and clinically significant bleeding.
Main Results:
- After PSM (1,869 per group), no significant differences in MACCE (HR 0.810, p=0.212) or bleeding (HR 1.056, p=0.795) at 1 year.
- Consistent outcomes across renal function strata.
- High switching rate from ticagrelor to clopidogrel; most clopidogrel users maintained therapy.
Conclusions:
- Initial ticagrelor and clopidogrel strategies showed no statistically significant differences in ischemic or bleeding outcomes in Korean AMI-RI patients.
- High treatment switching complicates interpretation.
- Findings are inconclusive and do not indicate therapeutic equivalence.
Background And Objectives:
The optimal P2Y12 inhibitor for patients with acute myocardial infarction and renal impairment (AMI-RI) remains unclear, particularly in East Asian populations. This study compared the real-world effectiveness and safety of initial ticagrelor versus clopidogrel therapy in Korean patients with AMI-RI.
Methods:
We analyzed 7,590 patients with AMI-RI (estimated glomerular filtration rate [eGFR] <90 mL/min/1.73 m²) from a nationwide multicenter registry. Of these, 3,793 received ticagrelor and 3,797 received clopidogrel as initial P2Y12 therapy. The primary efficacy endpoint was major adverse cardiac and cerebrovascular events (MACCEs), and the primary safety endpoint was clinically significant bleeding. Propensity score matching (PSM) was performed to adjust for baseline differences.
Results:
At 1 year, after PSM (n=1,869 per group), no significant differences were observed between ticagrelor and clopidogrel in the primary efficacy endpoint (MACCE; hazard ratio [HR], 0.810; p=0.212) or clinically significant bleeding (HR, 1.056; p=0.795). Renal function-stratified analyses showed consistent outcomes across eGFR categories, with no significant differences in MACCE after adjustment. During follow-up, a substantial proportion of patients initially treated with ticagrelor switched to clopidogrel, whereas most patients in the clopidogrel group maintained their initial therapy.
Conclusions:
Among Korean patients with AMI-RI, most clopidogrel users continued therapy, whereas many ticagrelor users switched during the 1-year follow-up. After propensity score adjustment, no statistically significant differences in ischemic or clinically significant bleeding outcomes were observed between the initial ticagrelor and clopidogrel strategies. These findings should be interpreted as inconclusive rather than indicative of equivalence.
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