Ticagrelor and The Risk of Staphylococcus Aureus Bacteremia and Other Infections

Aims To investigate the 1-year risks of Staphylococcus aureus bacteraemia (SAB), sepsis, and pneumonia in patients who underwent percutaneous coronary intervention and were treated with ticagrelor vs. clopidogrel. Methods and results In this nationwide observational cohort study, 26 606 patients who underwent urgent or emergent percutaneous coronary intervention (January 2011–December 2017) and initiated treatment with ticagrelor [N = 20 073 (75.5%); median age 64 years (25th–75th percentile 55–72 years); 74.8% men] or clopidogrel [N = 6533 (24.5%); median age 68 years (25th–75th percentile 58–77 years); 70.2% men] were identified using Danish nationwide registries. The 1-year standardized absolute risks of outcomes was calculated based on cause-specific Cox regression models, and average treatment effects between treatment groups were obtained as standardized differences in absolute 1-year risks. The absolute 1-year risk of SAB was 0.10% [95% confidence interval (CI), 0.05–0.15%] in the ticagrelor group and 0.29% (95% CI, 0.17–0.42%) in the clopidogrel group. Compared with clopidogrel, treatment with ticagrelor was associated with a significantly lower absolute 1-year risk of SAB [absolute risk difference −0.19% (95% CI, −0.32% to −0.05%), P value 0.006]. Likewise, treatment with ticagrelor was associated with a significantly lower absolute 1-year risk of sepsis [0.99% (95% CI, 0.83–1.14%) vs. 1.49% (95% CI, 1.17–1.80%); absolute risk difference −0.50% (95% CI, −0.86% to −0.14%), P value 0.007] and pneumonia [3.13% (95% CI, 2.86–3.39%) vs. 4.56% (95% CI, 4.03–5.08%); absolute risk difference −1.43% (95% CI, −2.03% to −0.82%), P value < 0.001] compared with clopidogrel. Conclusion Treatment with ticagrelor was associated with a significantly lower 1-year risk of SAB, sepsis, and pneumonia compared with clopidogrel.