The following is a summary of “Ticagrelor as Compared to Clopidogrel Following Percutaneous Coronary Intervention for Acute Coronary Syndrome,” published in the July 2023 issue of the Cardiovascular Disease by Wiens et al.

Dual antiplatelet therapy consisting of acetylsalicylic acid and a P2Y12 inhibitor has emerged as a fundamental treatment approach following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). While clopidogrel is commonly used, major society guidelines recommend higher-potency P2Y12 inhibitors due to their increased effectiveness. However, recent evidence has raised concerns regarding the magnitude of this benefit. Assessing the comparative effectiveness and safety of P2Y12 inhibitors in a real-world clinical context is crucial. This is a retrospective cohort study of all patients who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) in a Canadian province from January 1, 2015, to March 31, 2020. Baseline characteristics, encompassing co-morbidities, medications, and bleeding risk factors, were collected. Propensity matching was employed to conduct a comparative analysis of patients who were administered ticagrelor instead of clopidogrel. 

The primary outcome assessed was the occurrence of major adverse cardiovascular events (MACEs) within 12 months. MACEs were defined as mortality, nonfatal myocardial infarction, or unplanned revascularization. Secondary outcomes encompassed all-cause mortality, major bleeding events, stroke incidents, and all-cause hospitalizations. About 6,665 patients were enrolled; 2,108 were administered clopidogrel, and 4,214 were distributed ticagrelor. The individuals helped clopidogrel exhibited advanced age, presented with more co-morbidities encompassing cardiovascular risk factors, and demonstrated an elevated susceptibility to bleeding.

In a study involving 1,925 propensity score-matched pairs, it was found that ticagrelor was significantly associated with a reduced risk of major adverse cardiovascular events (hazard ratio 0.79, 95% CI 0.67 to 0.93, P <0.01) and hospitalization (hazard ratio 0.85, 95% CI 0.77 to 0.95, P <0.01). No discernible disparity was noted in the likelihood of experiencing significant hemorrhaging. A statistically insignificant trend toward decreased mortality risk from any cause was observed. In summary, within a real-world cohort at high risk, ticagrelor demonstrated a reduced risk of major adverse cardiovascular events and hospitalization for any reason when compared to clopidogrel following percutaneous coronary intervention for acute coronary syndrome.

Source: sciencedirect.com/science/article/abs/pii/S0002914923001558