Ticagrelor versus clopidogrel in acute myocardial infarction patients with multivessel disease; From Korea Acute Myocardial Infarction Registry-National Institute of Health

被引：18

作者：

Ahn, Joon Ho ^{[1
]}

Ahn, Youngkeun ^{[1
]}

Jeong, Myung Ho ^{[1
]}

Kim, Ju Han ^{[1
]}

Hong, Young Joon ^{[1
]}

Sim, Doo Sun ^{[1
]}

Kim, Min Chul ^{[1
]}

Hwang, Jin Yong ^{[2
]}

Yoon, Jung Han ^{[3
]}

Seong, In Whan ^{[4
]}

Hur, Seung-Ho ^{[5
]}

Oh, Seok Kyu ^{[6
]}

机构：

[1] Chonnam Natl Univ Hosp, Gwangju, South Korea

[2] Gyeongsang Natl Univ Hosp, Jinju, South Korea

[3] Yonsei Univ, Wonju Severance Christian Hosp, Wonju Coll Med, Wonju, South Korea

[4] Chungnam Natl Univ Hosp, Daejeon, South Korea

[5] Keimyung Univ, Dongsan Med Ctr, Daegu, South Korea

[6] Wonkwang Univ Hosp, Iksan, South Korea

来源：

JOURNAL OF CARDIOLOGY | 2020年 / 75卷 / 05期

基金：

新加坡国家研究基金会;

关键词：

Multivessel disease; Acute myocardial infarction; East Asian populations; Ticagrelor; PERCUTANEOUS CORONARY INTERVENTION; DUAL ANTIPLATELET THERAPY; EAST-ASIAN PATIENTS; PLATELET INHIBITION; CLINICAL-OUTCOMES; OPEN-LABEL; REVASCULARIZATION; EVENTS; TRIALS; ACS;

D O I：

10.1016/j.jjcc.2019.11.003

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: The clinical efficacy of ticagrelor is questionable in East Asian populations. Patients with acute myocardial infarction (AMI) with multivessel disease (MVD) are considered as high risk patients who might benefit from ticagrelor treatment. The purpose of this study is to compare the clinical effect of ticagrelor and clopidogrel in AMI patients with MVD in Korea. Methods and results: A total of 2275 patients between November 2011 and June 2015, diagnosed with AMI with MVD after successful percutaneous coronary intervention who were registered in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) were enrolled. Patients were divided into ticagrelor (n = 837) and clopidogrel group (n = 1438). The primary endpoint was major adverse cardiac events (MACE) defined as cardiac death, non-fatal MI, target vessel revascularization, or ischemic stroke during 2 years of clinical follow-up. Secondary endpoints were thrombolysis in myocardial infarction (TIMI) major or minor bleeding, net clinical event composed of MACE and TIMI major bleeding, any repeated percutaneous coronary intervention, heart failure requiring rehospitalization, and stent thrombosis. After propensity score matching analysis, the primary endpoint was lower in ticagrelor group compared to the clopidogrel group (8.6 % vs. 11.9 %; HR: 0.68; 95 % CI: 0.500.94; p = 0.018). The risk of TIMI major or minor bleedingwas higher in the ticagrelor group (10.8 % vs. 4.8 %; HR: 2.51; 95 % CI: 1.68-3.76; p< 0.001). The net clinical event was similar between ticagrelor and clopidogrel group (11.3 % vs. 13.6 %; HR 0.82; 95 % CI: 0.60-1.11; p = 0.195). Conclusion: Ticagrelor significantly reduced the risk of MACE than clopidogrel for AMI patients with MVD in Korea. However, the risk of TIMI major or minor bleeding was higher and the net clinical benefit was similar. Further large-scale multi-center randomized clinical trials are needed to clarify the proper use dual antiplatelet therapy in East Asian populations. (C) 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

引用

页码：478 / 484

页数：7

共 30 条

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