E-48 | Safety and Efficacy of Dual Antiplatelet Therapy With Ticagrelor vs Clopidogrel in a Predominantly Hispanic Population

Abstract

Current guidelines recommend potent P2Y12 platelet inhibitor in patients with acute coronary syndrome post percutaneous coronary intervention(PCI). However, ethnic and racial differences in responsiveness to P2Y12 have been reported. Little is known about the safety and efficacy of dual anti-platelet therapy (DAPT) with potent P2Y12 in the Hispanic population. We evaluated the risks and benefits associated with ticagrelor versus clopidogrel in a predominantly Hispanic population. We conducted a single center retrospective cohort study on patients who had PCI between Jan 2014 and Jun 2021. The safety endpoint was incident bleeding, defined as Bleeding Academic Research Consortium (BARC) ≥2events. Primary efficacy endpoints were all-cause mortality and major adverse cardiovascular event (MACE included death, myocardial infarction, stroke and revascularization). Kaplan Meier curve, log rank test and Cox proportional hazards models were performed to analyze time to specific event endpoint. A propensity scores-adjusted Cox model method was used in the adjusted analysis. Of 830 patients (age 62 ± 12 years, 67% males, 78% Hispanic), 357 (43%) patients received ticagrelor as their DAPT therapy. Patients who received clopidogrel at baseline were older and had more anemia, more bare metal stents and anticoagulation therapy. During an average follow-up of 2.8 ± 2.4 years, death occurred in 38 (4.6%) patients and bleeding events in 46 (5.5%) patients. After propensity scores-adjustment of baseline characteristics, BARC ≥2 bleeding events were not significantly different between ticagrelor and clopidogrel groups (4.76% versus 6.13%, hazard ratio [HR] =0.92, 95% CI:0.48-1.77, p=0.81). While there was no significant difference in the MACE event between the two P2Y12 groups (23.0% versus 22.7%, HR=1.08, 95% CI:0.79-1.48, p=0.65), the mortality rate was significantly lower in ticagrelor group (2.52% versus 6.13%, HR= 0.39, 95% CI:0.17-0.87, p=0.021). In a predominantly Hispanic population, ticagrelor use was associated with a lower mortality rate in patients post PCI compared to clopidogrel, with similar bleeding rates.