Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.
J Atheroscler Thromb. 2021 Aug 1;28(8):873-882. doi: 10.5551/jat.57265. Epub 2020 Sep 8.
The efficacy and safety of ticagrelor and clopidogrel in patients with stable coronary artery disease (SCAD) undergoing percutaneous coronary intervention (PCI) remain uncertain. Thus, this study aimed to compare the efficacy and safety of ticagrelor and clopidogrel in patients with SCAD treated with PCI.
A total of 9,379 patients with SCAD undergoing PCI who received dual antiplatelet therapy (DAPT) were consecutively enrolled in two groups, namely, ticagrelor (n=1,081) and clopidogrel (n=8,298) groups. Major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding events according to ticagrelor or clopidogrel use were compared.
After propensity matching (n=1,081 in each group), ticagrelor was associated with fewer MACCEs compared with clopidogrel (3.6% vs. 5.7%, hazard ratio [HR]=0.62, 95% confidence interval [CI] 0.41-0.93, p=0.019), and the difference between ticagrelor and clopidogrel for bleeding events was nonsignificant (4.0% vs. 3.2%, HR=1.24, 95% CI 0.79-1.93, p=0.356). On the other hand, the difference between ticagrelor and clopidogrel for net adverse clinical events was significant (4.1% vs. 6.0%, HR=0.67, 95% CI 0.46-0.98, p=0.039). In a multivariate analysis, the use of ticagrelor, number of stents, previous history of diabetes, previous history of smoking, and ACC/AHA type B2 or C lesions were considered independent predictors of MACCEs, while radial artery access, previous history of stroke, and weight ＜60kg were independent predictors of bleeding events. Conclusions Ticagrelor was associated with a lower incidence of MACCEs without an increased risk of bleeding events in patients with SCAD receiving PCI.
替格瑞洛和氯吡格雷在接受经皮冠状动脉介入治疗（PCI）的稳定型冠状动脉疾病（SCAD）患者中的疗效和安全性尚不确定。因此，本研究旨在比较替格瑞洛和氯吡格雷在接受 PCI 治疗的 SCAD 患者中的疗效和安全性。
共纳入 9379 例接受双重抗血小板治疗（DAPT）的 SCAD 行 PCI 患者，连续分为替格瑞洛（n=1081）和氯吡格雷（n=8298）两组。比较两组患者根据替格瑞洛或氯吡格雷的使用情况发生的主要不良心血管和脑血管事件（MACCEs）和出血事件。
在倾向评分匹配（每组 1081 例）后，与氯吡格雷相比，替格瑞洛发生 MACCEs 的风险较低（3.6%比 5.7%，风险比[HR]=0.62，95%置信区间[CI]0.41-0.93，p=0.019），替格瑞洛与氯吡格雷的出血事件差异无统计学意义（4.0%比 3.2%，HR=1.24，95%CI0.79-1.93，p=0.356）。另一方面，替格瑞洛与氯吡格雷的净不良临床事件差异有统计学意义（4.1%比 6.0%，HR=0.67，95%CI0.46-0.98，p=0.039）。多因素分析显示，使用替格瑞洛、支架数量、既往糖尿病史、既往吸烟史以及 ACC/AHA 类型 B2 或 C 病变是 MACCEs 的独立预测因素，而桡动脉入路、既往卒中史和体重＜60kg 是出血事件的独立预测因素。结论：替格瑞洛在接受 PCI 的 SCAD 患者中可降低 MACCEs 的发生率，且不会增加出血事件的风险。
