Efficacy And Safety Of Ticagrelor And Clopidogrel In Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Part ? Efficacy and safety of ticagrelor and clopidogrel in patients with stable coronary artery disease undergoing percutaneous coronary interventionObjective:The efficacy and safety of ticagrelor compared with clopidogrel in patients with stable coronary artery disease(SCAD)undergoing percutaneous coronary intervention(PCI)remain uncertain.This study aimed to compare the efficacy and safety of ticagrelor and clopidogrel in patients with SCAD treated with PCI.Methods:A total of 9379 patients with SCAD undergoing PCI who received dual antiplatelet therapy(DAPT)were consecutively enrolled in two groups;the ticagrelor group(n=1081)and the clopidogrel group(n=8298).We compared major adverse cardiovascular and cerebrovascular events(MACCEs)and Thrombolysis in Myocardial Infarction(TIMI)bleeding events according to ticagrelor or clopidogrel use.Results:After propensity matching(n=1081 in each group),ticagrelor was associated with fewer MACCEs than clopidogrel[3.6%vs 5.7%,hazard ratio(HR)=0.62,95%confidence interval(CI)0.41-0.93,P=0.019].Compared with clopidogrel,ticagrelor had a lower incidence of all-cause deaths and cardiogenic deaths(1.5%vs 3.0%,HR 0.50,95%CI 0.27-0.90,P=0.020;0.9%vs 2.0%,HR 0.47,95%CI 0.22-0.81,P=0.047).In a multivariate analysis,use of ticagrelor,number of stents,previous of diabetes,previous of smoke,and American College of Cardiology/American Heart Association(ACC/AHA)type B2 or C lesions were independent predictors of MACCEs.The difference between ticagrelor and clopidogrel for TIMI bleeding events was nonsignificant(4.0%vs 3.2%,HR 1.24,95%CI 0.79-1.93,P=0.356).No significant difference in the incidence of TIMI major bleeding and TIMI minor bleeding between the ticagrelor group and the clopidogrel group was observed.The difference between ticagrelor and clopidogrel for net adverse clinical events was significant(4.1%vs 6.0%,HR=0.67,95%CI 0.46-0.98,P=0.039).Conclusion:Ticagrelor was associated with a lower incidence of MACCEs without an increased risk of overall TIMI bleeding events in patients with SCAD receiving PCI.Part ? Efficacy and safety of ticagrelor and clopidogrel in patients with non-ST-segm en t elevation acute coronary syndrome undergoing percutaneous coronary interventionObjective:The efficacy and safety of ticagrelor and clopidogrel in East Asian patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)undergoing percutaneous coronary intervention(PCI)remain uncertain.This study aimed to compare the efficacy and safety of ticagrelor and clopidogrel in patients with NSTE-ACS treated with PCI.Methods:A total of 14011 patients with NSTE-ACS undergoing PCI who received dual antiplatelet therapy(DAPT)were consecutively enrolled in two groups:the ticagrelor group(n=2619)and the clopidogrel group(n=11392).We compared major adverse cardiovascular and cerebrovascular events(MACCEs)and Thrombolysis in Myocardial Infarction(TIMI)bleeding events according to ticagrelor or clopidogrel use.Results:After propensity matching(n=2619 in each group),ticagrelor was associated with fewer MACCEs than clopidogrel[4.5%vs 6.1%,hazard ratio(HR)0.65,95%confidence interval(CI)0.43-0.90,P=0.010].Compared with clopidogrel,ticagrelor had a lower incidence of cardiac death,all-cause death,and repeat revascularization.Multivariate COX regression analysis showed that the use of ticagrelor,radial artery access,age>75 years,myocardial infarction,and left ventricular ejection fraction<50%were independent risk predictors of MACCEs.The overall incidence of TIMI bleeding events in the ticagrelor group was higher than that in the clopidogrel group(6.3%vs 4.3%,HR 1.90,95%CI 1.22-2.80,P=0.001).Compared with clopidogrel,ticagrelor had a higher incidence of TIMI minor bleeding events(4.3%vs 2.7%,HR 1.74,95%CI 1.13-2.88,P=0.002).There was no significant difference in the incidence of TIMI major bleeding events and net adverse clinical events between the ticagrelor group and the clopidogrel group.After multivariate COX regression analysis,the use of ticagrelor,creatinine clearance<60ml/min/1.73m2,radial artery access,body weight<60kg,and use of proton pump inhibitors were independent risk predictors of TIMI bleeding events.Conclusion:Ticagrelor was associated with a lower incidence of MACCEs with an increased risk of overall TIMI bleeding events in patients with NSTE-ACS receiving PCI.Part ? Efficacy and safety of ticagrelor and clopidogrel in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary interventionObjective:The efficacy and safety of ticagrelor and clopidogrel in East Asian patients with ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI)remain uncertain.This study aimed to compare the efficacy and safety of ticagrelor and clopidogrel in patients with STEMI treated with PPCI.Methods:A total of 2535 patients with STEMI undergoing PPCI who received dual antiplatelet therapy(DAPT)were consecutively enrolled in two groups:the ticagrelor group(n=980)and the clopidogrel group(n=1555).We compared major adverse cardiovascular and cerebrovascular events(MACCEs)and Thrombolysis in Myocardial Infarction(TIMI)bleeding events according to ticagrelor or clopidogrel use.Results:After multivariate adjustment,the rate of MACCEs in the ticagrelor group was significantly lower than that in the clopidogrel group[4.8%vs 7.1%,hazard ratio(HR)0.60,95%confidence interval(CI)0.39-0.90,P=0.015].Ticagrelor had a lower incidence of myocardial infarction compared with clopidogrel(1.2%vs 2.5%,HR 0.53,95%CI 0.21-0.80,P=0.015).After multivariate Cox regression analysis,the use of ticagrelor,three-vessel disease,use of statins,previous PCI and diabetes were independent risk predictors of MACCEs.There was no significant difference in the overall rate of TIMI bleeding events between the two groups(6.6%vs 5.0%,HR 1.27,95%CI 0.83-1.97,P=0.076).The rate of TIMI minor bleeding events in the ticagrelor group was higher than that in the clopidogrel group(4.8%vs 3.1%,HR 2,15,95%CI 1.69-2.73,P=0.025).There was no significant difference in TIMI major bleeding events and net adverse clinical events between the two groups.Conclusion:Ticagrelor was associated with a lower incidence of MACCEs without an increased risk of overall TIMI bleeding events in patients with STEMI receiving PPCI.