Abstract 15223: Comparison of Net Clinical Benefit Between Clopidogrel-based and Ticagrelor-based Dual Antiplatelet Therapy in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention in China

Abstract

Introduction: Dual antiplatelet therapy (DAPT) increases the bleeding risk, which might outweigh the benefits of reduction in ischemic events in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI). This study aimed to evaluate the difference in net clinical benefits of clopidogrel-based DAPT compared with ticagrelor-based DAPT in ACS patients undergoing PCI in a real-world setting in China. Method: This study was conducted on three pre-existing PCI patient databases, two were from nation-wide studies with similar prospective designs and time-span: the BRIC-ACS(I) study and the COSTIC study, and other was from a tertiary hospital-maintained PCI patient database. The primary endpoint was net adverse clinical and cerebral event (NACCE), which was a composite of all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke and BARC ≥ 2 (excluding BARC 4) bleeding within 12 months after discharge. The efficacy outcome, major adverse cardiovascular events (MACE), was defined as a composite of all-cause death, non-fatal MI, and non-fatal stroke. The safety outcome was defined as BARC ≥ 2 (excluding BARC 4) bleeding. Kaplan-Meier survival curves, and Cox regression were applied to analyze the difference between the two groups after propensity score matching (PSM). Results: A total of 7,236 adult ACS patients who underwent PCI in the period of Jan 2014 to Oct 2017 were analyzed. Of them, 4,330 patients were included in post-PSM analyses. Patients prescribed clopidogrel and aspirin had a significant lower risk of NACCE within 12 months after discharge relative to those prescribed ticagrelor and aspirin [5.4% vs. 8.3%, hazard ratio (HR) = 0.63, 95% CI: 0.50 - 0.80]. While the two groups did not vary significantly in the risk of MACE (2.9% vs. 3.1%, HR = 0.91, 95% CI: 0.64 - 1.28), clopidogrel-based DAPT was associated with a significant lower risk of BARC ≥ 2 (excluding BARC 4) bleeding (2.9% vs. 5.5%, HR = 0.50, 95% CI: 0.37 - 0.68) compared to ticagrelor-based DAPT. Conclusion: In this real-world study, post-PCI ACS patients prescribed clopidogrel-based DAPT were associated with a reduction in NACCE and bleeding events without significant difference in MACE, compared to patients treated with ticagrelor-based DAPT.