Abstract 11414: Comparison of the Cardiovascular and Bleeding Risks in Patients With Acute Myocardial Infarction Newly Treated With Ticagrelor versus Clopidogrel in East Asia: A Nationwide Propensity-matched Cohort Study in Taiwan
Background: The Platelet Inhibition and Patient Outcomes (PLATO) trial showed that ticagrelor improved clinical outcomes in patients (pts) with acute coronary syndrome compared with clopidogrel. There were few real world data on the efficacy and safety of ticagrelor in East Asians in whom bleeding is a major concern with potent antithrombotic drugs.
Methods: We conducted a nationwide population-based cohort study by using 2012 to 2014 Taiwan National Health Insurance Research Database. The 18-month clinical outcomes in pts with acute myocardial infarction (MI) treated with ticagrelor vs. clopidogrel were compared. Overall, we identified 27,339 acute MI pts (mean age 62.2 years, 71% male) who survived 30 days after the acute MI attack and took dual antiplatelet agents. Cohorts of ticagrelor and clopidogrel were 1:8 matched based on propensity score. The primary efficacy endpoints were all-cause death, recurrent MI or ischemic stroke. The safety endpoints consisted of major gastrointestinal (GI) bleeding and intracerebral hemorrhage (ICH).
Results: In unmatched cohorts, ticagrelor-treated pts (n = 2,844) were younger with fewer comorbidities than clopidogrel-treated pts (n = 24,495). The 18-month primary efficacy endpoint rate was lower in ticagrelor group (10.1 vs. 18.3%, p < 0.001). In ticagrelor group, the risks of ICH (0.3%) and ICH + GI bleeding (2.9%) were similar to the data reported in the PLATO trial (ICH 0.3% and non-CABG related TIMI major bleeding 2.8%). After propensity matching, we obtained 2,389 ticagrelor users and 19,112 clopidogrel users in the cohort. After adjusting for clinical characteristics, the 18-month primary efficacy endpoint rate was 21% lower in ticagrelor than in clopidogrel group (10.5 vs. 16.0%, adjusted HR, 0.79; 95% CI, 0.68-0.93). The composite safety endpoint rate was not different between ticagrelor and clopidogrel group (3.2 vs. 4.1%, adjusted HR, 1.01; 95% CI, 0.74-1.37). Subgroup analyses show consistent benefits of ticagrelor in old pts (≥ 75 years) and in pts with diabetes, heart failure or previous MI.
Conclusions: In the real world acute MI Taiwanese pts, ticagrelor offered better cardiovascular protection than clopidogrel without increasing the major bleeding risk.
Author Disclosures: C. Lee: None. Y. Li: None. C. Cheng: None. Y. Kao Yang: None. T. Chao: None.
- © 2016 by American Heart Association, Inc.