One-year clinical outcomes of ticagrelor compared with clopidogrel after percutaneous coronary intervention in patients with acute myocardial infarction: From Korean Health Insurance Review and Assessment Data

Abstract

Background: Ticagrelor has been widely accepted in clinical practice for treatment of acute myocardial infarction (AMI), however its clinical safety and efficacy have not been revealed sufficiently in Asian populations. Methods and results: Among a total 20,270 patients (age <75 years) with AMI undergoing percutaneous coronary intervention who received dual antiplatelet therapy for at least 30 days, clinical outcomes at 1 year were assessed from the database of Health Insurance Review and Assessment Service in Korea between 2013 and 2014. Ticagrelor showed a significant effect on reduction of all-cause death [stabilized inverse probability of treatment weighted (sIPTW)-adjusted odds ratio (aOR) 0.57, 95% confidence interval (CI) 0.42-0.77, p < 0.001]. Stroke was also reduced by using ticagrelor (sIPTW-aOR 0.58, 95% CI 0.41-0.82, p = 0.002). Bleeding risk was not increased by ticagrelor use. There were nearly 30% of patients who switched from ticagrelor to different P2Y12 inhibitors. Switching P2Y12 inhibitors was associated with clinical adverse events including MI, stroke, and bleeding. Conclusions: Among patients aged younger than 75 years, ticagrelor was associated with lower incidence of all-cause mortality. Stroke risk was also reduced in patients with a prescription for ticagrelor without an increase in bleeding risk.

Real-World Bleeding and Ischemic Events in Asian Patients on P2Y12-Inhibitors After Percutaneous Coronary Intervention: A National Claims Data Analysis

“…However, unlike our results, the risk of bleeding was not different among the three P2Y12 inhibitors, whereas the risks of death and composite ischemic events were lower in ticagrelor users than in clopidogrel users. A recent study conducted by Kim et al, using Korean HIRA claims data [18], also found that the risk of bleeding did not differ between ticagrelor and clopidogrel, which contradicted our results. These inconsistencies may have resulted from differences in study design and population characteristics.…”

“…Premature discontinuation of DAPT has been known to increase the risk of ischemic events [28]. According to recent real-world studies, premature discontinuation of DAPT was less frequent in patients using clopidogrel than in those using potent P2Y12 inhibitors [17,18]. In addition, clopidogrel was associated with higher adherence than potent P2Y12 inhibitors.…”

“…The PHILO study also reported that the rates of major bleeding and composite events of MI, stroke and death from vascular causes were numerically higher in the ticagrelor group than in the clopidogrel group, although the difference was not significant [16]. Recent real-world studies also reported conflicting results on the comparative risks of bleeding and ischemic events between potent P2Y12 inhibitors and clopidogrel [17][18][19]. Moreover, only a few studies have compared the long-term safety and efficacy of different P2Y12 inhibitors in a real-world population undergoing PCI.…”

Serum interleukin-18 levels as a predictor for patients with genetic dysfunction of cytochrome P450 2C19 in dual antiplatelet therapy with clopidogrel

“…Given previous reports that a higher incidence of cardiovascular events in DAPT with clopidogrel after PCI occurred in patients with genetic dysfunction of CYP2C19 [7,10,11], cardiovascular events after PCI may occur in the non-EM patients even if they have ever indicated PRU 208, PRU 230, or PRU 262 at a certain point in DAPT with clopidogrel [2][3][4][5]. Nevertheless, in order to prevent considerable cardiovascular events after PCI in patients with PRU 208, PRU 230, or PRU 262 in DAPT with clopidogrel [2][3][4][5], it may be desirable to know both PRU and the CYP2C19 phenotype of the patients and thereby require an appropriate change to another P2Y 12 inhibitor from clopidogrel [20].…”

The current status and outcomes of in-hospital P2Y12 receptor inhibitor switching in Korean patients with acute myocardial infarction

“…Therefore, in actual clinical practice, it tends to be frequently used to intentionally switch between a potent P2Y12RI and clopidogrel depending on the patient's baseline characteristics, clinical conditions, or physician's decision. However, while a previous study has shown that early post-discharge switches from potent P2Y12RI to clopidogrel (the P-C) were not associated with an increased risk of ischemic events in stabilized AMI patients [9], another study has found that P2Y12RI switching after discharge from index admission was associated with adverse clinical adverse events during 1-year follow-up [10]. However, the current status and clinical outcomes of in-hospital P2Y12RI switching remain unknown.…”