Comparison of short-term clinical outcomes between ticagrelor versus clopidogrel in patients with acute myocardial infarction undergoing successful revascularization; from Korea Acute Myocardial Infarction Registry—National Institute of Health

Park, Keun-Ho; Jeong, Jin‐Ok; Ahn, Youngkeun; Ahn, Tae Hoon; Seung, Ki Bae; Oh, Dong Joo; Choi, Dong‐Joo; Kim, Hyo–Soo; Gwon, Hyeon Cheol; Seong, In Whan; Hwang, Kyung Kuk; Chae, Shung Chull; Kim, Kwon-Bae; Kim, Young Jo; Soo, Kwang; Oh, Seok Kyu; Chae, Jei Keon

doi:10.1016/j.ijcard.2016.04.044

Cited by 69 publications

(71 citation statements)

References 30 publications

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“…Moreover, it may result from a favourable ratio between the unavoidable haemorrhagic risk and protection from ischaemic events. The observational registry by Park et al [17] on ticagrelor in a STEMI population yielded contrasting results, showing that it did not reduce the risk of ischaemic events but was associated with an increased risk of bleeding compared with clopidogrel after controlling for propensity score. That study was conducted in Korea, thus it may lack external validity in Europe due to genetic variations and difference in patient characteristics, such as BMI or age.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ticagrelor versus clopidogrel in real-world patients with ST elevation myocardial infarction: 1-year results by propensity score analysis

Vercellino

Sanchez

Boasi

et al. 2017

BMC Cardiovasc Disord

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BackgroundEuropean guidelines recommend the use of ticagrelor versus clopidogrel in patients with ST elevation myocardial infarction (STEMI). This recommendation is based on inconclusive results and subanalyses from clinical trials. Few data are available on the effects of ticagrelor in a real-world population.MethodsTo compare the effects of ticagrelor and clopidogrel in a real-world STEMI population, we conducted a pre-post case-control study examining all patients with STEMI included in the Cardio-STEMI Sanremo registry between February 2011 and June 2013. Cases and controls were defined according to P2Y12 inhibitors, correcting the bias due to lack of randomization by propensity score analysis. Ticagrelor was introduced in 2012 in both in-hospital and pre-hospital settings independently of this study.ResultsOf the 416 patients enrolled in the Cardio-STEMI registry, 401 with a definite diagnosis of STEMI were included in this study. One hundred forty-two patients received ticagrelor and 259 received clopidogrel. Regarding clinical presentation and procedural data, those in the ticagrelor group had lower CRUSADE scores (23 [14–36] vs 27 [18–38]; p = 0.015] but a higher proportion of radial access (33% vs 14%; p < 0.001), percutaneous coronary intervention (PCI; 92% vs 81 %; p = 0.002) and primary PCI ≤ 12 h (82% vs 66%; p = 0.001). The patients in the ticagrelor group had a higher procedural success rate (100% vs. 96%; p = 0.044). There was no difference in Bleeding Academic Research Consortium bleeding and in unadjusted incidence of hospital major adverse cardiovascular events (MACE; cardiac death, myocardial infarction, or stroke) but there was a significant reduction in unadjusted cardiac hospital death in the ticagrelor group (0.7% vs 5.4%; p = 0.024). After correcting for propensity score, hospital death (p = 0.22) and hospital MACE (p = 0.96) did not differ in both groups. The unadjusted survival at 1 year after STEMI was higher in the ticagrelor group (97.8% vs 87.8%; p = 0.024), and this result was confirmed by propensity score analysis (hazard ratio = 0.29 [0.08–0.99]; p = 0.048).ConclusionsIn this real-word propensity score analysis, ticagrelor did not affect the risk of MACE during the hospital phase, or the incidence of hospital bleeding in patients with STEMI. However, in this mono-centric experience, ticagrelor resulted in improved 1-year survival, even after correction by propensity score.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0524-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…The sole large observational registry about ticagrelor in STEMI population yielded results that were in contrast with the PLATO trial, with no improvement in ischaemic events and a higher rate of bleeding for ticagrelor versus clopidogrel [17]. …”

Section: Introductionmentioning

confidence: 99%

Ticagrelor versus clopidogrel in real-world patients with ST elevation myocardial infarction: 1-year results by propensity score analysis

Vercellino

Sanchez

Boasi

et al. 2017

BMC Cardiovasc Disord

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“…The study is expected to complete the scheduled enrollment of approximately 13 000 patients in October 2015, and the follow‐up duration is up to 5 years for each patient. The aims and protocols of the registries have been published elsewhere …”

Section: Methodsmentioning

confidence: 99%

“…The aims and protocols of the registries have been published elsewhere. 14,15 The protocol of the present study was reviewed and approved by the institutional review board at each participating center of KAMIR-KNIH. Data on demographics, procedures, medical/surgical history, medications and vital signs at admission/discharge, serum laboratory test results, in-hospital outcomes and discharge status, and clinical outcomes were collected from the KAMIR-KNIH database.…”

Section: Study Design and Populationmentioning

confidence: 99%

Association between pulse pressure at discharge and clinical outcomes in patients with acute myocardial infarction: From the KAMIR‐Korean‐NIH registry

Park

Kang

Kim

et al. 2019

J of Clinical Hypertension

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Pulse pressure (PP) is affected by arterial stiffness and is a predictor of cardiovascular events. However, value and utility of PP assessment in patients with acute myocardial infarction (AMI) remain less clear. We aimed to evaluate the association between PP and cardiovascular events in surviving patients with AMI at discharge. A total of 11 944 surviving patients with AMI at discharge from a Korean nationwide registry were included. Blood pressure was checked just before discharge. Noncardiac death and major adverse cardiovascular events (MACEs) including cardiac death, AMI, and stroke after discharge were analyzed. The median follow‐up duration was 368 (IQR 339, 388) days. The rate of MACEs and cardiac death was higher in groups with the lowest PP (PP < 20 mm Hg) and highest PP (PP ≥ 71 mm Hg) and lowest in the group with PP of 31‐40 mm Hg. With PP of 31‐40 mm Hg as reference, univariate analysis showed a U‐shaped association between the risk of MACEs (PP ≤ 20 mm Hg: hazard ratio [HR] 2.3; PP ≥ 71 mm Hg: HR 2.7) or cardiac death (PP ≤ 20 mm Hg: HR 2.6; PP ≥ 71 mm Hg: HR 3.1) and PP. In multivariate analysis, the curve changed from being U‐shaped to J‐shaped, and HR for PP ≥ 71 mm Hg (1.2 for MACEs and 1.4 cardiac death) decreased and HR for PP < 20 (2.1 for MACEs and 2.4 for cardiac death) did not significantly decrease after adjustment for cardiovascular risk factors. Our findings indicate that PP is a strong independent prognostic factor of MACEs and cardiac death in surviving patients with AMI. Low PP is a more significant independent predictor of MACEs and cardiac death than high PP in surviving patients after AMI.

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“…Both ticagrelor and prasugrel, compared to clopidogrel, increased non-coronary artery bypass graft surgery (CABG) bleeding [3,4]. Recent observational studies in Korean patients with acute MI showed that the use of potent P2Y12 blockers was associated with higher bleeding risk with similar rates of ischemic events [5][6][7], suggesting that the bleeding risk needs to be weighed against the ischemic risk, especially in East Asians known to be prone to bleeding [8,9]. In the present study, we sought to evaluate the association of potent P2Y12 blockers with ischemic and bleeding outcomes in patients with NSTEMI undergoing drug-eluting stent (DES) placement using a largescale, multi-center, nationwide acute MI database in Korea.…”

Section: Introductionmentioning

confidence: 99%

Association of potent P2Y12 blockers with ischemic and bleeding outcomes in non-ST-segment elevation myocardial infarction

Sim

Jeong

Kim

et al. 2019

Journal of Cardiology

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A B S T R A C TBackground: Potent P2Y12 blockers are preferred in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). However, the risk of bleeding remains a major concern. We assessed the association of potent P2Y12 blockers with ischemic and bleeding outcomes in patients with NSTEMI. Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health database, 4927 patients with NSTEMI receiving drug-eluting stents (DES) were divided into potent P2Y12 blocker (ticagrelor or prasugrel, n = 901) and clopidogrel (n = 3180) groups. Propensity-matched 12-month ischemic and bleeding events were compared. Patients who received anticoagulants or who discontinued P2Y12 blockers or switched between potent P2Y12 blockers and clopidogrel were excluded. Results: In the overall population, patients at higher ischemic and bleeding risks more often received clopidogrel. After propensity matching (n = 901 in each group), 12-month rates of major adverse cardiac

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Comparison of short-term clinical outcomes between ticagrelor versus clopidogrel in patients with acute myocardial infarction undergoing successful revascularization; from Korea Acute Myocardial Infarction Registry—National Institute of Health

Cited by 69 publications

References 30 publications

Ticagrelor versus clopidogrel in real-world patients with ST elevation myocardial infarction: 1-year results by propensity score analysis

Ticagrelor versus clopidogrel in real-world patients with ST elevation myocardial infarction: 1-year results by propensity score analysis

Association between pulse pressure at discharge and clinical outcomes in patients with acute myocardial infarction: From the KAMIR‐Korean‐NIH registry

Association of potent P2Y12 blockers with ischemic and bleeding outcomes in non-ST-segment elevation myocardial infarction

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