ISSN 2996-8215
International Journal of Cardiology | Vol. 3, No. 9, September 2012 | pp. 65–72
DOI: 10.46882/2012/IJC/000042
Original Research Article
Comparison of Ticagrelor versus Clopidogrel in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention
Yukihiro Tanaka¹, Shinji Kato¹, Takuya Kobayashi²
¹Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
²Division of Interventional Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
Abstract:
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the cornerstone of management for acute coronary syndrome (ACS). Ticagrelor provides faster, more consistent platelet inhibition than clopidogrel. This prospective observational study evaluated the real-world clinical efficacy and safety of ticagrelor versus clopidogrel in ACS patients undergoing percutaneous coronary intervention (PCI). We analyzed 380 consecutive ACS patients (ST-segment elevation myocardial infarction and non-ST-segment elevation ACS) who underwent successful PCI and received either ticagrelor (180 mg loading dose, 90 mg twice daily, n = 190) or clopidogrel (300 to 600 mg loading dose, 75 mg once daily, n = 190). The primary efficacy endpoint was a composite of cardiovascular death, myocardial infarction (MI), or stroke at 12 months. The safety endpoint was major bleeding according to PLATO criteria. At 12 months, the primary composite endpoint was significantly lower in the ticagrelor group than in the clopidogrel group (6.8% vs. 13.2%, hazard ratio: 0.50, 95% CI: 0.26–0.94, p = 0.03), driven primarily by lower rates of recurrent MI. The rate of definite stent thrombosis was also reduced with ticagrelor (0.5% vs. 2.1%, p < 0.05). The incidence of overall PLATO-defined major bleeding did not differ significantly between groups (8.4% vs. 7.9%, p = 0.85); however, non-CABG related bleeding and transient dyspnea were more frequent in the ticagrelor cohort (5.3% vs. 2.1%, p = 0.04). In real-world clinical practice, ticagrelor significantly reduces ischemic events and stent thrombosis in ACS patients undergoing PCI compared with clopidogrel, without significantly increasing overall major bleeding complications.
Keywords: Acute coronary syndrome, Percutaneous coronary intervention, Ticagrelor, Clopidogrel, Dual antiplatelet therapy, Stent thrombosis
Received: June 02, 2012; Revised: July 15, 2012; Accepted: August 04, 2012; Published: September 20, 2012
Citation: International Journal of Cardiology, 2012, Vol. 3, No. 9, pp. 65–72, DOI: 10.46882/2012/IJC/000042