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. 2025 Apr 22;23(1):38.
doi: 10.1186/s12959-025-00721-z.

Clopidogrel vs. ticagrelor in ST-elevation myocardial infarction complicated by cardiogenic shock undergoing primary PCI : Findings from a National, multicenter registry

Can Zhou #  1 , Minghui Zhang #  1 , Zixu Zhao #  1 , Enze Li  1 , Yichen Zhao  1 , Wei Luo  1 , Keyang Zheng  1   2 , Yu Liu  1 , Chengqian Yin  1 , Xinyong Zhang  3 , Hai Gao  4 , Dong Zhao  5 , Changsheng Ma  1
Affiliations

Clopidogrel vs. ticagrelor in ST-elevation myocardial infarction complicated by cardiogenic shock undergoing primary PCI : Findings from a National, multicenter registry

Can Zhou et al. Thromb J. .

Abstract

Background: Although ticagrelor is recommended as opposed to clopidogrel in antiplatelet strategy for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI), evidence is limited in patients with cardiogenic shock (CS).

Objective: This study aims to evaluate the comparative efficacy and safety profile of ticagrelor and clopidogrel in patients with STEMI-CS undergoing pPCI.

Methods: Using data from a nationwide, multicenter registry, eligible patients were stratified into clopidogrel or ticagrelor based on the choice of P2Y12 inhibitors within 24 h of first medical contact. Multivariable-adjusted Cox regression analyses, along with Cox models adjusted for propensity score matching and inverse probability treatment weighting were conducted to compare outcomes between ticagrelor and clopidogrel. The efficacy and safety outcomes were in-hospital all-cause mortality and major bleeding.

Results: Among 729 STEMI-CS patients in our cohort, 403 received clopidogrel and 326 received ticagrelor. Multivariable-adjusted Cox regression analyses showed that ticagrelor was not associated with a significant difference in all-cause mortality (adjusted HR: 1.04; 95% CI: 0.69-1.56; p = 0.840) and major bleeding (adjusted HR: 1.30; 95% CI: 0.62-2.76; p = 0.489) compared to clopidogrel. Consistent results were found in the analyses adjusted by propensity score matching and inverse probability of treatment weighting.

Conclusions: Our findings suggest that the choice of either ticagrelor or clopidogrel was feasible as a P2Y12 inhibitor for dual anti-platelet strategy in STEMI-CS patients undergoing pPCI, as no significant difference between these two agents was observed in all-cause mortality and major bleeding during hospitalization.

Trial registration: ClinicalTrials.gov, NCT02306616. Registered 29 November 2014.

Keywords: Cardiogenic shock; P2Y12 inhibitor; Primary percutaneous coronary intervention; ST-segment elevation myocardial infarction.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Institutional Review Board of Beijing Anzhen Hospital, and was conducted according to the guidelines outlined in the Declaration of Helsinki. Informed consent was secured from all individual participants involved in the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of our research. Abbreviation: STEMI: ST-segment elevation myocardial infarction; CS: cardiogenic shock; pPCI: primary percutaneous coronary intervention; DAPT: dual antiplatelet therapy.
Fig. 2
Fig. 2
Kaplan-Meier curve of outcomes during the 15-day in-hospital period in the whole study population: (A) mortality, (B) major bleeding, (C) major adverse cardiovascular event (MACE), and (D) net adverse cardiovascular event (NACE). Abbreviation: clo: clopidogrel; tica: ticagrelor; HR: hazard ratio; CI: confidence interval.
Fig. 3
Fig. 3
Subgroup analysis for in-hospital all-cause mortality. Abbreviation: BMI: Body Mass Index; LM: left main coronary artery; LAD: left anterior descending coronary artery; RCA: right coronary artery; LCX: left circumflex coronary artery; MVD: multivessel coronary artery disease; GPI: glycoprotein IIb/IIIa inhibitors; PCI: Percutaneous Coronary Intervention; MI: myocardial infarction; HR: hazard ratio; CI: confidence interval.
See this image and copyright information in PMC

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