Abstract
BackgroundPatients with coronary chronic total occlusion (CTO) require effective antiplatelet therapy after percutaneous coronary intervention (PCI). Ticagrelor has more pronounced platelet inhibition than clopidogrel. However, the most appropriate dose of ticagrelor in East Asian populations remains unclear.MethodWe compared ticagrelor (180 mg loading dose, 90 mg twice daily thereafter and 120 mg loading dose, 60 mg twice daily thereafter) and clopidogrel (300 mg loading dose, 75 mg daily thereafter) for prevention of cardiovascular events in 525patients with CTO undergoing PCI.ResultsThe rate of in-hospital major adverse cardiac and cerebral events (MACCE) was not different between the groups. At 1-year follow-up, target vessel revascularization (TVR) in both ticagrelor groups were significantly lower than that in the clopidogrel group (p = 0.047); TVR was significantly decreased in 60 mg ticagrelor compared to standard dose clopidogrel (p = 0.046). At 1-year follow-up, overall MACCE in both ticagrelor groups were significantly lower than that in the clopidogrel group (p = 0.023). Kaplan–Meier analysis showed MACCE-free survival was significantly higher in both ticagrelor groups than in the clopidogrel group (p = 0.024). During hospitalization, minor bleeding was significant increased in the 90 mg ticagrelor group (p = 0.021). At 1-year follow-up, risk of major and minor bleeding were significantly increased in the 90 mg ticagrelor group.ConclusionIn East Asian patients with CTO undergoing PCI, 60 mg ticagrelor was as effective as 90 mg, at the same time significantly reduced risk of bleeding.
Highlights
chronic total occlusion (CTO) was defined as thrombolysis in myocardial infarction (TIMI) grade-0 flow with a duration of 3 months, documented angiographically or clinically defined [1]
At 1-year follow-up, target vessel revascularization (TVR) in both ticagrelor groups were significantly lower than that in the clopidogrel group (p = 0.047); TVR was significantly decreased in 60 mg ticagrelor compared to standard dose clopidogrel (p = 0.046)
Kaplan–Meier analysis showed major adverse cardiac and cerebral events (MACCE)-free survival was significantly higher in both ticagrelor groups than in the clopidogrel group (p = 0.024)
Summary
CTO was defined as thrombolysis in myocardial infarction (TIMI) grade-0 flow with a duration of 3 months, documented angiographically or clinically defined [1]. Ticagrelor is a reversible antagonist of the P2Y12 receptor with a more rapid onset and more pronounced platelet inhibition, it is widely used in dual antiplatelet therapy following PCI. Most of the patients included in these clinical studies were from European and American Caucasian populations. An increasing number of studies have confirmed that the risk of thrombosis and hemorrhagic disease in East Asian populations is different from those in Caucasian populations [7, 8]. It is important to investigate suitable doses of ticagrelor in East Asian populations. Patients with coronary chronic total occlusion (CTO) require effective antiplatelet therapy after percutaneous coronary intervention (PCI). The most appropriate dose of ticagrelor in East Asian populations remains unclear
Sign-in/Register to view highlights & summary 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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
