Abstract
Background and ObjectivesIt is unclear whether more potent P2Y12 inhibitors are of benefit to older patients who are at high risk for both ischemia and bleeding. We conducted an observational study to compare the clinical outcomes of clopidogrel and ticagrelor uses in older patients with an acute coronary syndrome (ACS).MethodsOlder patients (aged ≥65 years) with ACS who underwent percutaneous coronary intervention (PCI) were divided into clopidogrel-treated and ticagrelor-treated groups. The primary observational endpoint was the occurrence of net adverse clinical and cerebral events (NACCEs) during a 12-month period, which is defined as the composite endpoint of all-cause death, myocardial infarction (MI), stroke, stent thrombosis, urgent coronary revascularization, and clinically significant bleeding. The secondary endpoints were clinically significant bleeding and major adverse clinical and cerebral events (MACCEs).ResultsThis study included a total of 2,611 patients. Of them, 1,636 received clopidogrel and 975 received ticagrelor. Between patients receiving clopidogrel and those receiving ticagrelor, no significant differences were noted in NACCE (8.4 vs. 9.7%, respectively; adjusted hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.66–1.12) or MACCE (7.1 vs. 7.0%, respectively; adjusted HR, 1.13; 95% CI, 0.83–1.55) during the 12-month follow-up period. In contrast, the occurrence of clinically significant bleeding was significantly less in clopidogrel-treated patients compared with that in ticagrelor-treated patients (27, 1.7%, vs. 31, 3.2%, respectively; adjusted HR, 0.42; 95% CI, 0.25–0.69). Stratified analyses revealed no significant association between age (≥75 years vs. <75 years) and treatment condition in terms of primary or secondary endpoints.ConclusionThis study showed that clopidogrel and ticagrelor had comparable net clinical benefits in patients with ACS aged ≥65 years. Additionally, clopidogrel was associated with a significantly lower risk of major bleeding than ticagrelor without an increase in ischemic risk. These findings suggest that clopidogrel is an effective alternative to the more potent P2Y12 inhibitor ticagrelor in older patients.
Highlights
Dual antiplatelet therapy (DAPT), which comprises a P2Y12 inhibitor and aspirin, is the standard antiplatelet therapy strategy in patients with acute coronary syndrome (ACS) who are undergoing percutaneous coronary intervention (PCI)
The raw data showed compared with clopidogrel-treated patients, ticagrelor-treated patients had lower average age, higher proportion of men, differences in the occurrence of segment elevation MI (STEMI), previous PCI with stenting, multiple-vessel diseases, and hypertension (Table 1)
Based on the abovementioned considerations and rationale, we conducted the present real-world study to compare the clinical outcomes of clopidogrel and ticagrelor—a more potent P2Y12 inhibitor—uses in older patients with ACS aged ≥65 years who underwent PCI
Summary
Dual antiplatelet therapy (DAPT), which comprises a P2Y12 inhibitor and aspirin, is the standard antiplatelet therapy strategy in patients with acute coronary syndrome (ACS) who are undergoing percutaneous coronary intervention (PCI). Several previous studies have compared the clinical outcomes of using clopidogrel and potent antiplatelet inhibitors in older patients with ACS; the outcomes have not yet been fully determined. A previous study in patients with ACS with high-bleeding risk showed that clopidogrel and ticagrelor were comparable in terms of ischemia risk reduction [9]. Most of the existing studies have been conducted in Caucasian patients; studies that compare the use of clopidogrel and ticagrelor in older Asian patients are worth conducting It is unclear whether more potent P2Y12 inhibitors are of benefit to older patients who are at high risk for both ischemia and bleeding. We conducted an observational study to compare the clinical outcomes of clopidogrel and ticagrelor uses in older patients with an acute coronary syndrome (ACS)
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