Ticagrelor vs. Clopidogrel After Complex Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease.

Ziwei Xi,Yong Wang,Yuejin Yang,Hong Qiu,Tingting Guo,Jianan Li,Yang Li,Runlin Gao,Kefei Dou,Shubin Qiao,Bo Xu,Yongjian Wu,Jianfeng Zheng,Weixian Yang

doi:10.3389/fcvm.2021.768190

Abstract

Background: Patients undergoing complex percutaneous coronary intervention (PCI) have an increased risk of cardiovascular events. Whether potent antiplatelet therapy after complex PCI improves outcomes in patients with stable coronary artery disease (SCAD) remains unclear.Objectives: To assess the efficacy and safety of ticagrelor vs. clopidogrel in patients with SCAD undergoing complex PCI.Methods: Patients with a diagnosis of SCAD and undergoing PCI during January 2016 to December 2018 were selected from an institutional registry. The primary efficacy endpoint was major adverse cardiac events (MACE) within 12 months after PCI. The primary safety endpoint was major bleeding.Results: Among 15,459 patients with SCAD included in this analysis, complex PCI was performed in 6,335 (41.0%) patients. Of patients undergoing complex PCI, 1,123 patients (17.7%) were treated with ticagrelor. The primary efficacy outcome after complex PCI occurred in 8.6% of patients in the ticagrelor group and 11.2% in the clopidogrel group. Compared with clopidogrel, ticagrelor decreased the risk of MACE in patients undergoing complex PCI [adjusted hazard ratio (HR): 0.764; 95% confidence interval (CI): 0.615 to 0.949; p = 0.015], but not in non-complex PCI (p for interaction = 0.001). There was no significant difference in incidence of major bleeding between patients treated with ticagrelor and clopidogrel (p = 0.221), while ticagrelor was associated with an increased risk of minor bleeding (adjusted HR: 3.099; 95% CI: 2.049 to 4.687; p < 0.001).Conclusion: In patients with SCAD and undergoing complex PCI, ticagrelor could substantially reduce the risk of adverse cardiovascular outcomes without increasing the risk of major bleeding compared with clopidogrel.

Highlights

Dual antiplatelet therapy, consisting of aspirin and a P2Y12 receptor inhibitor, is the standard of care for patients undergoing percutaneous coronary intervention (PCI) to prevent atherothrombotic events [1]
It is important to balance between the risk of ischemia and bleeding and identify patients who might benefit from potent antiplatelet therapy in order to improve the outcomes of patients with stable coronary artery disease (SCAD) after PCI
Whether ticagrelor is superior to clopidogrel for the prevention of ischemic events in patients presenting with SCAD remains uncertain

Summary

Introduction

Dual antiplatelet therapy, consisting of aspirin and a P2Y12 receptor inhibitor, is the standard of care for patients undergoing percutaneous coronary intervention (PCI) to prevent atherothrombotic events [1]. It is noteworthy that the greater benefits of the more potent P2Y12 inhibitors ticagrelor in previous studies come at the cost of a higher risk of bleeding compared with clopidogrel [4, 5]. It is important to balance between the risk of ischemia and bleeding and identify patients who might benefit from potent antiplatelet therapy in order to improve the outcomes of patients with SCAD after PCI. Patients undergoing complex percutaneous coronary intervention (PCI) have an increased risk of cardiovascular events. Whether potent antiplatelet therapy after complex PCI improves outcomes in patients with stable coronary artery disease (SCAD) remains unclear

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Results

Conclusion