Ticagrelor vs. Clopidogrel After Complex Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease

Background: Patients undergoing complex percutaneous coronary intervention (PCI) have an increased risk of cardiovascular events. Whether potent antiplatelet therapy after complex PCI improves outcomes in patients with stable coronary artery disease (SCAD) remains unclear.Objectives: To assess the e...

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Autores principales:	Ziwei Xi, Jianan Li, Hong Qiu, Tingting Guo, Yong Wang, Yang Li, Jianfeng Zheng, Kefei Dou, Bo Xu, Yongjian Wu, Shubin Qiao, Weixian Yang, Yuejin Yang, Runlin Gao
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	ticagrelor clopidogrel antiplatelet therapy complex PCI stable coronary artery disease Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/23912a509bd14d68ab05f3d2dafa8513
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spelling	oai:doaj.org-article:23912a509bd14d68ab05f3d2dafa85132021-11-22T06:35:38ZTicagrelor vs. Clopidogrel After Complex Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease2297-055X10.3389/fcvm.2021.768190https://doaj.org/article/23912a509bd14d68ab05f3d2dafa85132021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.768190/fullhttps://doaj.org/toc/2297-055XBackground: Patients undergoing complex percutaneous coronary intervention (PCI) have an increased risk of cardiovascular events. Whether potent antiplatelet therapy after complex PCI improves outcomes in patients with stable coronary artery disease (SCAD) remains unclear.Objectives: To assess the efficacy and safety of ticagrelor vs. clopidogrel in patients with SCAD undergoing complex PCI.Methods: Patients with a diagnosis of SCAD and undergoing PCI during January 2016 to December 2018 were selected from an institutional registry. The primary efficacy endpoint was major adverse cardiac events (MACE) within 12 months after PCI. The primary safety endpoint was major bleeding.Results: Among 15,459 patients with SCAD included in this analysis, complex PCI was performed in 6,335 (41.0%) patients. Of patients undergoing complex PCI, 1,123 patients (17.7%) were treated with ticagrelor. The primary efficacy outcome after complex PCI occurred in 8.6% of patients in the ticagrelor group and 11.2% in the clopidogrel group. Compared with clopidogrel, ticagrelor decreased the risk of MACE in patients undergoing complex PCI [adjusted hazard ratio (HR): 0.764; 95% confidence interval (CI): 0.615 to 0.949; p = 0.015], but not in non-complex PCI (p for interaction = 0.001). There was no significant difference in incidence of major bleeding between patients treated with ticagrelor and clopidogrel (p = 0.221), while ticagrelor was associated with an increased risk of minor bleeding (adjusted HR: 3.099; 95% CI: 2.049 to 4.687; p < 0.001).Conclusion: In patients with SCAD and undergoing complex PCI, ticagrelor could substantially reduce the risk of adverse cardiovascular outcomes without increasing the risk of major bleeding compared with clopidogrel.Ziwei XiJianan LiJianan LiHong QiuTingting GuoYong WangYang LiJianfeng ZhengKefei DouBo XuYongjian WuShubin QiaoWeixian YangYuejin YangRunlin GaoFrontiers Media S.A.articleticagrelorclopidogrelantiplatelet therapycomplex PCIstable coronary artery diseaseDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ticagrelor clopidogrel antiplatelet therapy complex PCI stable coronary artery disease Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	ticagrelor clopidogrel antiplatelet therapy complex PCI stable coronary artery disease Diseases of the circulatory (Cardiovascular) system RC666-701 Ziwei Xi Jianan Li Jianan Li Hong Qiu Tingting Guo Yong Wang Yang Li Jianfeng Zheng Kefei Dou Bo Xu Yongjian Wu Shubin Qiao Weixian Yang Yuejin Yang Runlin Gao Ticagrelor vs. Clopidogrel After Complex Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease
description	Background: Patients undergoing complex percutaneous coronary intervention (PCI) have an increased risk of cardiovascular events. Whether potent antiplatelet therapy after complex PCI improves outcomes in patients with stable coronary artery disease (SCAD) remains unclear.Objectives: To assess the efficacy and safety of ticagrelor vs. clopidogrel in patients with SCAD undergoing complex PCI.Methods: Patients with a diagnosis of SCAD and undergoing PCI during January 2016 to December 2018 were selected from an institutional registry. The primary efficacy endpoint was major adverse cardiac events (MACE) within 12 months after PCI. The primary safety endpoint was major bleeding.Results: Among 15,459 patients with SCAD included in this analysis, complex PCI was performed in 6,335 (41.0%) patients. Of patients undergoing complex PCI, 1,123 patients (17.7%) were treated with ticagrelor. The primary efficacy outcome after complex PCI occurred in 8.6% of patients in the ticagrelor group and 11.2% in the clopidogrel group. Compared with clopidogrel, ticagrelor decreased the risk of MACE in patients undergoing complex PCI [adjusted hazard ratio (HR): 0.764; 95% confidence interval (CI): 0.615 to 0.949; p = 0.015], but not in non-complex PCI (p for interaction = 0.001). There was no significant difference in incidence of major bleeding between patients treated with ticagrelor and clopidogrel (p = 0.221), while ticagrelor was associated with an increased risk of minor bleeding (adjusted HR: 3.099; 95% CI: 2.049 to 4.687; p < 0.001).Conclusion: In patients with SCAD and undergoing complex PCI, ticagrelor could substantially reduce the risk of adverse cardiovascular outcomes without increasing the risk of major bleeding compared with clopidogrel.
format	article
author	Ziwei Xi Jianan Li Jianan Li Hong Qiu Tingting Guo Yong Wang Yang Li Jianfeng Zheng Kefei Dou Bo Xu Yongjian Wu Shubin Qiao Weixian Yang Yuejin Yang Runlin Gao
author_facet	Ziwei Xi Jianan Li Jianan Li Hong Qiu Tingting Guo Yong Wang Yang Li Jianfeng Zheng Kefei Dou Bo Xu Yongjian Wu Shubin Qiao Weixian Yang Yuejin Yang Runlin Gao
author_sort	Ziwei Xi
title	Ticagrelor vs. Clopidogrel After Complex Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease
title_short	Ticagrelor vs. Clopidogrel After Complex Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease
title_full	Ticagrelor vs. Clopidogrel After Complex Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease
title_fullStr	Ticagrelor vs. Clopidogrel After Complex Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease
title_full_unstemmed	Ticagrelor vs. Clopidogrel After Complex Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease
title_sort	ticagrelor vs. clopidogrel after complex percutaneous coronary intervention in patients with stable coronary artery disease
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/23912a509bd14d68ab05f3d2dafa8513
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Ticagrelor vs. Clopidogrel After Complex Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease

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