1. Efficacy of clopidogrel and ticagrelor under NT-proBNP in hospitalized ST-elevation acute coronary syndrome patients on percutaneous coronary intervention: CCC-ACS Project Analysis
- Author
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Mengge Zhou, Xin Zhao, Dong Zhao, Guannan Ai, Xiaoxu Yang, Jiyuan Zhang, Yongchen Hao, Yifei Liu, Xiaozeng Wang, Miaohan Qiu, Pei Xu, Yaling Han, Lei Zhang, and Chonghuai Gu
- Subjects
Ticagrelor ,medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,P2Y12 ,Internal medicine ,Natriuretic Peptide, Brain ,Humans ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Aspirin ,business.industry ,ST elevation ,Percutaneous coronary intervention ,Stroke Volume ,medicine.disease ,Clopidogrel ,Peptide Fragments ,Treatment Outcome ,Cardiology ,ST Elevation Myocardial Infarction ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Risk stratification with specific biomarkers is proposed for tailored P2Y12 inhibitor therapy in patients with STEMI.This nationwide registry and quality improvement study is from November 1, 2014, to June 30, 2017. In total, 11,512 STEMI patients received aspirin and P2Y12 receptor inhibitor (clopidogrel or ticagrelor) and underwent PCIs in hospitals. Of the patients, 2992 were prescribed ticagrelor and 8520 clopidogrel. The primary effectiveness outcome was major adverse cardiovascular and cerebrovascular events (MACCE: cardiac death, myocardial infarction, stent thrombosis, in-hospital ischemic stroke). The primary safety outcome was in-hospital major bleeding.MACCE incidence was lower in the ticagrelor group than in the clopidogrel group (0.8% versus 1.2%; P=0.046), but under different NT-proBNP levels, cumulative hazards of MACCE were without statistical significance. Bleeding rates were higher in the ticagrelor group than in the clopidogrel group (all bleeding: 9.9% versus 6.9%, P0.001; major bleeding: 4.0% versus 2.7%, P0.001). The higher cumulative hazard of bleeding could be identified in the Kaplan-Meier curves. In the multivariate analysis, ticagrelor increased bleeding events, compared with clopidogrel, at NT-proBNP1800 ng/L patients (all bleeding: HR 1.46; 95%CI, 1.07-2.01; major bleeding: HR 1.68, 95%CI, 1.03-2.74), but a low effect was found in those with lower NT-proBNP level. Subgroup analyses show that ticagrelor increased major bleeding in patients with left ventricular ejection fraction (LVEF)0.50 (HR 3.29; 95% CI 1.61-6.74) (interaction p=0.03).We found that ticagrelor, compared with clopidogrel, increased bleeding complications in hospitalized patients with NT-proBNP1800 ng/L, especially in patients with EF 0.50.
- Published
- 2020