Article Impact Level: HIGH Data Quality: STRONG Summary of The American Journal of Cardiology, 210, 241–248. https://doi.org/10.1016/j.amjcard.2023.10.046 Dr. Sukru Akyuz et al.
Points
- The study compared the clinical outcomes of clopidogrel and ticagrelor in 5,713 patients with acute coronary syndrome (ACS) at high bleeding or ischemic risk.
- Using the Cox proportional hazard regression model adjusted with the inverse probability weighted approach, the research assessed primary outcomes such as all-cause and secondary outcomes, including in-hospital death, ACS, target vessel revascularization, stent thrombosis, stroke, and clinically significant or major bleeding.
- The median follow-up duration was 53.6 months, and the analysis revealed that all-cause death and secondary outcomes did not significantly differ between clopidogrel and ticagrelor in the overall population and subgroups of patients at high bleeding or ischemic risk.
- The findings suggested that both ticagrelor and clopidogrel are associated with comparable clinical outcomes in ACS patients, regardless of bleeding and ischemic risk.
- The study emphasized the need for a personalized approach in choosing between potent (ticagrelor) and less potent (clopidogrel) P2Y12 inhibitors in ACS management beyond bleeding and ischemic risk considerations.
Summary
The research aimed to assess the comparative clinical outcomes of clopidogrel and ticagrelor in patients with acute coronary syndrome (ACS) at high bleeding or ischemic risk. The retrospective study included 5,713 ACS patients, and the Cox proportional hazard regression model was adjusted using the inverse probability weighted approach to mitigate treatment selection bias. The primary clinical outcome assessed was all-cause death, while secondary outcomes encompassed in-hospital death, ACS, target vessel revascularization, stent thrombosis, stroke, and clinically significant or major bleeding. The median follow-up duration was 53.6 months.
Following the multivariable Cox model utilizing the inverse probability weighted approach, the study found that all-cause death in the overall population and subgroups of patients at high bleeding risk and/or at high ischemic risk did not exhibit significant differences between clopidogrel and ticagrelor. Additionally, rates for secondary outcomes, including in-hospital death, ACS, target vessel revascularization, stent thrombosis, stroke, and clinically significant or major bleeding, were similar between the two groups.
In conclusion, the findings indicated that ticagrelor and clopidogrel demonstrated comparable clinical outcomes in patients with ACS, irrespective of bleeding and ischemic risk. These results suggest that the choice between potent (ticagrelor) and less potent (clopidogrel) P2Y12 inhibitors should be individualized based on factors beyond bleeding and ischemic risk, emphasizing the need for a personalized approach in ACS management.
Link to the article: https://www.ajconline.org/article/S0002-9149(23)01198-0/abstract
References Akyuz, S., Calik, A. N., Yaylak, B., Onuk, T., Eren, S., Kolak, Z., Mollaalioglu, F., Durak, F., Cetin, M., & Tanboga, I. H. (2024). Comparison of ticagrelor and clopidogrel in patients with acute coronary syndrome at high bleeding or ischemic risk. The American Journal of Cardiology, 210, 241–248. https://doi.org/10.1016/j.amjcard.2023.10.046
