Main Takeaway

  • Risk for net adverse clinical events (NACE) was not significantly different between ticagrelor at 12 months compared with clopidogrel
    • Study population: 62,580 patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) in routine clinical practice
  • Ticagrelor was associated with higher risks for haemorrhagic events and dyspnoea vs clopidogrel

Why This Matters

  • Recent observational studies question whether ticagrelor vs clopidogrel is associated with better outcomes in routine clinical practice
    • Current guidelines: recommend ticagrelor with aspirin in preference to clopidogrel in patients with ACS

Study Design

Retrospective cohort study: 183,579 patients (age range, 30-89 years) with ACS who underwent PCI and received ticagrelor or clopidogrel

Patients were matched using propensity score:

- Ticagrelor (n=31,290)

   - Clopidogrel (n=31,290)

Primary endpoint: NACE at 12 months

  • Ischaemic events
    [recurrent acute myocardial infarction, revascularisation or ischaemic stroke]
  • Haemorrhagic events
    [haemorrhagic stroke or gastrointestinal bleeding]

Secondary outcomes: NACE or mortality, all-cause mortality, composite ischaemic events, composite haemorrhagic events, individual components of the primary outcome, dyspnoea at 12 months

Key Results

95.5% of matched patients used aspirin with ticagrelor or clopidogrel among the 31,290 propensity-matched pairs

The risk for NACE was not significantly different between ticagrelor and clopidogrel groups (HR, 1.05; 95% CI, 1.00-1.10; P=0.06)

  • No significant difference was found between the 2 groups for:
    • NACE or mortality (HR, 1.03; 95% CI, 0.98-1.08; P=0.21)
    • Ischaemic events (HR, 1.03; 95% CI, 0.98-1.08; P=0.32)
    • All-cause mortality (HR, 0.97; 95% CI, 0.81-1.16; P=0.74)
  • Ticagrelor vs clopidogrel group showed a significantly higher risk for:
    • Haemorrhagic events (HR, 1.35; 95% CI, 1.13-1.61; P=0.001)
    • Dyspnoea (HR, 1.21; 95% CI, 1.17-1.26; P<0.001)

Limitations

  • The study did not include information on aspirin dosage, angiographic findings, or PCI procedure
  • The burden of overall bleeding events could have been underestimated or overestimated
  • Neither the proportion of patients who switched antiplatelet drugs nor its effects were quantified
  • The effect of pre-treatment with an antiplatelet agent was not assessed
  • The mortality rate might have been underestimated
  • Patients who used prasugrel for dual antiplatelet therapy were not included

    You SC et al. Association of Ticagrelor vs Clopidogrel With Net Adverse Clinical Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. JAMA. 2020;324(16):1640-1650. doi:10.1001/jama.2020.16167.

MAT-BH-2200184/v2/Jun 2023