Initial Antiplatelet Strategy and 1-Year Outcomes in East Asian Patients With Acute Myocardial Infarction and Renal...

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.