Abstract
Background The increased thrombotic risk in patients with acute coronary syndrome (ACS) and diabetes highlights the need for adequate antithrombotic protection. We aimed to compare the 6-month clinical outcomes between ticagrelor and clopidogrel in patients with ACS and diabetes. Methods and Results The study was a single-center, prospective, randomized, open-label, blinded endpoint, and controlled registry trial. A total of 270 ACS patients with diabetes were randomly assigned in a 1 : 1 ratio to either the ticagrelor group or the clopidogrel group. Follow-up was performed for 6 months, and the data on efficacy outcomes and bleeding events were collected. At 6 months, complete follow-up data were available for 266 (98.5%) of 270 patients, and 4 were lost to follow-up. There was no significant difference in the survival rate of the effective endpoints between the ticagrelor group (n = 133) and the clopidogrel group (n = 133) (HR 0.83, 95% CI 0.44–1.56, p = 0.561), but the incidence of bleeding events in the ticagrelor group was higher than that in the clopidogrel group (HR 1.76, 95% CI 1.00–3.10, p = 0.049). Conclusion Ticagrelor did not improve the composite of nonfatal MI, target vessel revascularization, rehospitalization, stroke, and death from any cause; however, it significantly increased the incidence of bleeding events defined by the Bleeding Academic Research Consortium (BARC) criteria in Chinese patients with ACS and diabetes during the 6-month follow-up compared with clopidogrel.
Highlights
Acute coronary syndrome (ACS) is one of the major lethal and disabling diseases that affect millions of people worldwide [1]
The higher thrombotic risk in patients with acute coronary syndrome (ACS) and diabetes highlights the need for adequate antithrombotic protection [6]
At 6 months, 266 (98.5%) of the 270 patients had complete follow-up data available, and 4 patients (2 in the ticagrelor group and 2 in the clopidogrel group) were lost to follow-up due to missing phone numbers or their own reasons (Supplemental Figure 1). Both the clopidogrel group (n = 133) and the ticagrelor group (n = 133) were well balanced in almost all baseline characteristics (Table 1), including demographics, medical history, medication, biomedical indicators, and the results of coronary angiography, patients with hypertension were more likely to be in the clopidogrel group (p = 0:038)
Summary
Acute coronary syndrome (ACS) is one of the major lethal and disabling diseases that affect millions of people worldwide [1]. Previous studies in patients with ACS and diabetes showed a 1.8-fold increase in cardiovascular deaths and a 1.4-fold increase in myocardial infarctions (MIs) at 2 years compared to nondiabetic patients [5]. Multiple factors, such as hyperglycemia, endothelial dysfunction, and oxidative stress, play a vital role in platelet hyperreactivity in diabetic patients. Ticagrelor did not improve the composite of nonfatal MI, target vessel revascularization, rehospitalization, stroke, and death from any cause; it significantly increased the incidence of bleeding events defined by the Bleeding Academic Research Consortium (BARC) criteria in Chinese patients with ACS and diabetes during the 6-month follow-up compared with clopidogrel
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call