기타학회
| Comparison of the efficacy and safety between ticagrelor and clopidogrel in patients with acute coronary syndrome undergoing percutaneous coronary intervention | ||
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Department of Pharmacy, Asan Medical Center, South Korea
Introduction In the absence of complications, the European Society of Cardiology and American Heart Association guidelines recommend ticagrelor and prasugrel over clopidogrel in dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). However, ticagrelor and prasugrel are associated with an increased bleeding risk, and the thrombotic and bleeding tendencies differ between Asian and non-Asian populations. Therefore, domestic studies and guidelines are warranted to optimize antiplatelet therapy in Asian patients. This study aimed to compare the efficacy and safety of ticagrelor and clopidogrel in patients with ACS undergoing PCI, elucidating optimal antiplatelet therapy tailored to individual patient needs.
Method This retrospective observational study included patients with ACS undergoing PCI who were treated with either ticagrelor or clopidogrel in a tertiary hospital between January 2022 and June 2023. Major adverse cardiovascular events (MACEs) were analyzed to evaluate efficacy, while major bleeding events were analyzed for safety.
Results The study comprised 460 patients, including 129 (28.0%) and 331 (72.0%) patients treated with ticagrelor and clopidogrel, respectively. Analysis of patient characteristics showed that the patients in the clopidogrel group were significantly older, while the proportion of male patients was higher in the ticagrelor group (p<0.001 for both). The proportion of myocardial infarction among ACS types was higher in the ticagrelor group (p=0.009), hypertension and diabetes were more common in the clopidogrel group (p=0.02, p=0.001), and the length of hospital stay was significantly longer in the clopidogrel group (p=0.007). To minimize bias, propensity score matching (1:1) was performed, resulting in 49 matched pairs (98 patients). In the outcome analysis after matching, there was no significant difference in MACEs between the ticagrelor and clopidogrel groups (24.5% vs. 18.4%, p=0.460), and no significant difference in major bleeding events between the two groups (0.0% vs. 4.1%, p=0.495).
Conclusion There was no significant difference in the efficacy and safety between ticagrelor and clopidogrel in patients with ACS undergoing PCI. Further multicenter, prospective studies are needed to provide stronger evidence for the optimal selection of antiplatelet agents. |
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