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Ticagrelor improves clinical outcomes in patients with acute coronary syndrome (ACS),and without increased the rates of major bleeding. We studied the efficacy and safety of ticagrelor in patients with ACS undergoing drug-eluting stent (DES) implantation.
We retrospectively enrolled 4401 ACS patients who undergoing DES at Beijing Anzhen Hospital between September 1, 2014 and August 31, 2015. All patients received aspirin. 2166 patients were assigned to ticagrelor (180 mg loading dose followed by 90 mg twice a day) and 2344 to clopidogrel (300-600 mg loading dose or continuation with maintenance dose followed by 75 mg per day). The primary endpoints were MACE (defined as a composite of cardiovascular death, myocardial infarction [MI], stroke and stent thrombosis). The safety endpoint was the incidence of bleeding events defined according to Bleeding Academic Research Consortium (BARC).
Compared with clopidogrel, ticagrelor significantly reduced the incidence of MACE (2.94 vs. 4.21, HR 0.64, 95% CI 0.42-0.99; P=0.04) and cardiovascular death (0.13 vs. 1.88, HR 0.07, 95% CI 0.02-0.30; P<0.0001). There was no difference between clopidogrel and ticagrelor groups in the rates of major bleeding (BARC 3 to 5) (1.27 vs. 1.27, HR=0.97, 95% CI 0.50-1.87; P=0.93), but ticagrelor increased risk of BARC 1 and 2 bleeding.
Ticagrelor seems to be a better option than clopidogrel for patients with ACS undergoing DES implantation.