Keun-Ho Park1, Myung Ho Jeong2, Youngkeun Ahn3, Tae Hoon Ahn4, Ki Bae Seung5, Dong Joo Oh6, Dong-Joo Choi7, Hyo-Soo Kim8, Hyeon Cheol Gwon9, In Whan Seong10, Kyung Kuk Hwang11, Shung Chull Chae12, Kwon-Bae Kim13, Young Jo Kim14, Kwang Soo Cha15, Seok Kyu Oh16, Jei Keon Chae17. 1. Chosun University Hospital, Gwangju, Republic of Korea. 2. Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net. 3. Chonnam National University Hospital, Gwangju, Republic of Korea. 4. Gachon University Gil Medical Center, Incheon, Republic of Korea. 5. The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea. 6. Korea University Guro Hospital, Seoul, Republic of Korea. 7. Seoul National University Bundang Hospital, Seoul, Republic of Korea. 8. Seoul National University Hospital, Seoul, Republic of Korea. 9. Sungkyunkwan Universtiy Samsung Medical Center, Seoul, Republic of Korea. 10. hungnam National Universtiy Hospital, Daejeon, Republic of Korea. 11. Chungbuk National University Hospital, Cheongju, Republic of Korea. 12. Kyungpook National University Hospital, Daegu, Republic of Korea. 13. Keimyung University Dongsan Medical Center, Daegu, Republic of Korea. 14. Yeungnam University Hospital, Daegu, Republic of Korea. 15. Pusan National University Hospital, Busan, Republic of Korea. 16. Wonkwang University Hospital, Iksan, Republic of Korea. 17. Chonbuk National University Hospital, Jeonju, Republic of Korea.
Abstract
BACKGROUND: Although ticagrelor has been well-known to improve clinical outcomes in patients with acute myocardial infarction (AMI) without increased bleeding risk, its clinical impacts have not been well established in East Asian patients. METHODS: Between November 2011 and June 2015, a total of 8010 patients (1377 patients were prescribed ticagrelor and 6633 patients clopidogrel) undergoing successful revascularization were analyzed from Korea Acute Myocardial Infarction Registry-National Institute of Health. The patients who discontinued or occurred in-hospital switching between two antiplatelet agents were excluded. RESULTS: After propensity score matching (1377 pairs), no difference in the composite of cardiac death, MI, stroke, or target vessel revascularization at 6months was observed between two groups (4.2% vs. 4.9%, p=0.499). However, the incidences of in-hospital Thrombolysis In Myocardial Infarction (TIMI) major and minor bleeding were higher in ticagrelor than clopidogrel (2.6% vs. 1.2%, p=0.008; 3.8% vs. 2.5%, p=0.051). The in-hospital mortality was higher in patients with than those without TIMI major bleeding (11.3% vs. 0.9%, p<0.001). In a subgroup analysis, a higher risk for in-hospital TIMI major bleeding with ticagrelor was observed in patients≥75years or with body weight<60kg (odd ratio [OR]=3.209; 95% confidence interval [CI]=1.356-7.592) and in those received trans-femoral intervention (OR=1.996; 95% CI=1.061-3.754). CONCLUSIONS: Our study shows that ticagrelor did not reduce ischemic events yet, however, was associated with increased risk of bleeding complications compared with clopidogrel. Further large-scale, long-term, randomized trials should be required to assess the outcomes of ticagrelor for East Asian patients with AMI.
BACKGROUND: Although ticagrelor has been well-known to improve clinical outcomes in patients with acute myocardial infarction (AMI) without increased bleeding risk, its clinical impacts have not been well established in East Asian patients. METHODS: Between November 2011 and June 2015, a total of 8010 patients (1377 patients were prescribed ticagrelor and 6633 patientsclopidogrel) undergoing successful revascularization were analyzed from Korea Acute Myocardial Infarction Registry-National Institute of Health. The patients who discontinued or occurred in-hospital switching between two antiplatelet agents were excluded. RESULTS: After propensity score matching (1377 pairs), no difference in the composite of cardiac death, MI, stroke, or target vessel revascularization at 6months was observed between two groups (4.2% vs. 4.9%, p=0.499). However, the incidences of in-hospital Thrombolysis In Myocardial Infarction (TIMI) major and minor bleeding were higher in ticagrelor than clopidogrel (2.6% vs. 1.2%, p=0.008; 3.8% vs. 2.5%, p=0.051). The in-hospital mortality was higher in patients with than those without TIMI major bleeding (11.3% vs. 0.9%, p<0.001). In a subgroup analysis, a higher risk for in-hospital TIMI major bleeding with ticagrelor was observed in patients≥75years or with body weight<60kg (odd ratio [OR]=3.209; 95% confidence interval [CI]=1.356-7.592) and in those received trans-femoral intervention (OR=1.996; 95% CI=1.061-3.754). CONCLUSIONS: Our study shows that ticagrelor did not reduce ischemic events yet, however, was associated with increased risk of bleeding complications compared with clopidogrel. Further large-scale, long-term, randomized trials should be required to assess the outcomes of ticagrelor for East Asian patients with AMI.