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. 2021 Aug 1;28(8):873-882.
doi: 10.5551/jat.57265. Epub 2020 Sep 8.

Efficacy and Safety of Ticagrelor and Clopidogrel in Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Jianan Li  1 , Hong Qiu  1 , Lirong Yan  1 , Tingting Guo  1 , Yong Wang  1 , Yang Li  1 , Jianfeng Zheng  1 , Yida Tang  1 , Bo Xu  1 , Shubin Qiao  1 , Yuejin Yang  1 , Runlin Gao  1
Affiliations

Efficacy and Safety of Ticagrelor and Clopidogrel in Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Jianan Li et al. J Atheroscler Thromb. .

Abstract

Aim: The efficacy and safety of ticagrelor and clopidogrel in patients with stable coronary artery disease (SCAD) undergoing percutaneous coronary intervention (PCI) remain uncertain. Thus, this study aimed to compare the efficacy and safety of ticagrelor and clopidogrel in patients with SCAD treated with PCI.

Methods: A total of 9,379 patients with SCAD undergoing PCI who received dual antiplatelet therapy (DAPT) were consecutively enrolled in two groups, namely, ticagrelor (n=1,081) and clopidogrel (n=8,298) groups. Major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding events according to ticagrelor or clopidogrel use were compared.

Results: After propensity matching (n=1,081 in each group), ticagrelor was associated with fewer MACCEs compared with clopidogrel (3.6% vs. 5.7%, hazard ratio [HR]=0.62, 95% confidence interval [CI] 0.41-0.93, p=0.019), and the difference between ticagrelor and clopidogrel for bleeding events was nonsignificant (4.0% vs. 3.2%, HR=1.24, 95% CI 0.79-1.93, p=0.356). On the other hand, 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). In a multivariate analysis, the use of ticagrelor, number of stents, previous history of diabetes, previous history of smoking, and ACC/AHA type B2 or C lesions were considered independent predictors of MACCEs, while radial artery access, previous history of stroke, and weight ＜60kg were independent predictors of bleeding events. Conclusions Ticagrelor was associated with a lower incidence of MACCEs without an increased risk of bleeding events in patients with SCAD receiving PCI.

Keywords: Clopidogrel; Percutaneous coronary intervention; Stable coronary artery disease; Ticagrelor.

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Figures

Fig.1.
Fig.1.
Flow chart
Fig.2.
Fig.2.
(A) Kaplan–Meier estimation of the cumulative incidence of 1-year efficacy outcomes; (B) Kaplan–Meier estimation of the cumulative incidence of 1-year safety outcomes; (C) Kaplan–Meier estimation of the cumulative incidence of 1-year net adverse clinical events; (D) Kaplan–Meier estimation of the cumulative incidence of 1-year efficacy outcomes after propensity score matching; (E) Kaplan–Meier estimation of the cumulative incidence of 1-year safety outcomes after propensity score matching; (F) Kaplan–Meier estimation of the cumulative incidence of 1-year net adverse clinical events after propensity score matching
Fig.3.
Fig.3.
(A) Independent predictors of major adverse cardiac and cerebrovascular events; (B) independent predictors of bleeding events. HR, hazard ratio; CI, confidence interval; ACC/AHA, American College of Cardiology/American Heart Association
See this image and copyright information in PMC

References

    1. Paarup Dridi N, Johansson PI, Lønborg JT, Clemmensen P, Radu MD, Qayyum A, Pedersen F, Kollslid R, Helqvist S, Saunamäki K, Kelbæk H, Jørgensen E, Engstrøm T, Holmvang L. Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome. Platelets, 2015; 26: 521-529 - PubMed
    1. Patrono C, Baigent C, Hirsh J, Roth G. Antiplatelet drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008; 133: 199S-233S - PubMed
    1. Kuliczkowski W, Witkowski A, Polonski L, Watala C, Filipiak K, Budaj A, Golanski J, Sitkiewicz D, Pregowski J, Gorski J, Zembala M, Opolski G, Huber K, Arnesen H, Kristensen SD, De Caterina R. Interindividual variability in the response to oral antiplatelet drugs: a position paper of the Working Group on antiplatelet drugs resistance appointed by the Section of Cardiovascular Interventions of the Polish Cardiac Society, endorsed by the Working Group on Thrombosis of the European Society of Cardiology. Eur Heart J, 2009; 30: 426-435 - PubMed
    1. Hochholzer W, Trenk D, Bestehorn HP, Fischer B, Valina CM, Ferenc M, Gick M, Caputo A, Büttner HJ, Neumann FJ. Impact of the degree of peri-interventional platelet inhibition after loading with clopidogrel on early clinical outcome of elective coronary stent placement. J Am Coll Cardiol, 2006; 48: 1742-1750 - PubMed
    1. Sibbing D, Morath T, Braun S, Stegherr J, Mehilli J, Vogt W, Schömig A, Kastrati A, von Beckerath N. Clopidogrel response status assessed with Multiplate point-of-care analysis and the incidence and timing of stent thrombosis over six months following coronary stenting. Thromb Haemost, 2010; 103: 151-159 - PubMed