Risk of bleeding and ischemia in elderly East Asian patients with diabetes mellitus treated with either clopidogrel or ticagrelor: From Korea Acute Myocardial Infarction Registry-V

Abstract

Background: The risk of bleeding and ischemia in patients with acute myocardial infarction (AMI) who have undergone percutaneous coronary intervention (PCI) is a common concern for physicians, with added conflict over prescribing a potent P2Y12 inhibitor. In particular, elderly East Asian patients with diabetes mellitus (DM) invoke a heightened concern. Methods: We analyzed 839 patients who were enrolled in the Korea Acute Myocardial Infarction Registry-V, older than 75 years, with DM, had an AMI, and had undergone PCI. Propensity score matching (PSM) and cox regression analyses were performed to compare the bleeding and ischemic risks between the two groups. After PSM, 699 patients (ticagrelor: clopidogrel = 233:466) were analyzed. Patients with Bleeding Academic Research Consortium (BARC) type ≥2 bleed and those at ischemic risk were analyzed based on major adverse cardiac and cerebrovascular events. Results: Cox regression analyses showed the type of antiplatelet therapy did not affect the incidence of BARC type ≥2 bleeds (HR, 1.67; 95% CI: 0.86–3.22). Use of the transradial approach for PCI, use of statins, and successful PCI lowered the risk of bleeding. In contrast, low body mass index (BMI) increased the risk of bleeds. In the aspect of ischemia, there was no difference based on the antiplatelet agents used (HR, 1.00; 95% CI: 0.68–1.46). Low BMI, hemoglobin <9 g/dL, high Killip class, left ventricular ejection fraction <40%, and multivessel disease increased ischemic risk. Post thrombolysis in myocardial infarction flow grade ≥3, use of angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, beta blockers and statins decreased the risk. Conclusions: In this Korean prospective cohort study, there was no difference in the risks for bleeding and ischemia, based on the use of ticagrelor or clopidogrel, in elderly Korean patients with DM. To determine the optimal antiplatelet agents for these patients, large scale randomized controlled trials are warranted. Trial registration: KCT0008355