Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea.
Department of Cardiovascular Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea.
J Korean Med Sci. 2021 Nov 1;36(42):e268. doi: 10.3346/jkms.2021.36.e268.
Although ticagrelor is known to increase the bleeding risk compared to clopidogrel in East Asian patients, its clinical benefits in patients with acute myocardial infarction (AMI) without high bleeding risk (HBR) remains unknown.
A total of 7,348 patients who underwent successful percutaneous coronary intervention (PCI) from the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), between November 2011 and December 2015, were divided into two groups according to the Academic Research Consortium for HBR criteria (KAMIR-HBR, 2,469 patients; KAMIR-non HBR, 4,879 patients). We compared in-hospital major adverse cardiovascular events (MACEs, defined as a composite of cardiac death, non-fatal myocardial infarction, or stroke), and the thrombolysis in myocardial infarction (TIMI) major bleeding between ticagrelor and clopidogrel in the KAMIR-HBR and the KAMIR-non HBR groups, respectively.
After propensity score matching, ticagrelor had a higher incidence of in-hospital TIMI major bleeding than clopidogrel in all patients (odds ratio [OR], 1.683; 95% confidence interval [CI], 1.010-2.805; = 0.046) and the KAMIR-HBR group (OR, 3.460; 95% CI, 1.374-8.714; = 0.008). However, there was no significant difference in in-hospital TIMI major bleeding between ticagrelor and clopidogrel in the KAMIR-non HBR group (OR, 1.436; 95% CI, 0.722-2.855; = 0.303). No differences were observed in the cumulative incidences of in-hospital and 6-month MACEs between ticagrelor and clopidogrel in both groups.
The bleeding risk of ticagrelor was attenuated in Korean patients with AMI without HBR. Appropriate patient selection could reduce in-hospital bleeding complications associated with ticagrelor in Korean patients with AMI who underwent successful PCI.
虽然替格瑞洛与氯吡格雷相比，会增加东亚患者的出血风险，但在无高出血风险（HBR）的急性心肌梗死（AMI）患者中，其临床获益仍不清楚。
共纳入 2011 年 11 月至 2015 年 12 月期间在韩国急性心肌梗死注册研究-国家卫生研究院（KAMIR-NIH）中接受成功经皮冠状动脉介入治疗（PCI）的 7348 例患者，根据学术研究联合会的 HBR 标准将患者分为两组（KAMIR-HBR 组，2469 例；KAMIR-non HBR 组，4879 例）。我们分别比较了替格瑞洛和氯吡格雷在 KAMIR-HBR 组和 KAMIR-non HBR 组中的住院期间主要不良心血管事件（MACE，定义为心脏死亡、非致命性心肌梗死或中风的复合事件）和血栓形成溶栓治疗（TIMI）大出血发生率。
在进行倾向评分匹配后，替格瑞洛在所有患者（比值比 [OR]，1.683；95%置信区间 [CI]，1.010-2.805； = 0.046）和 KAMIR-HBR 组（OR，3.460；95%CI，1.374-8.714； = 0.008）中的住院期间 TIMI 大出血发生率均高于氯吡格雷。然而，在 KAMIR-non HBR 组中，替格瑞洛与氯吡格雷的住院期间 TIMI 大出血发生率无显著差异（OR，1.436；95%CI，0.722-2.855； = 0.303）。两组患者的住院期间和 6 个月的 MACE 累计发生率均无差异。
在无 HBR 的韩国 AMI 患者中，替格瑞洛的出血风险降低。在接受成功 PCI 的韩国 AMI 患者中，适当的患者选择可降低替格瑞洛相关的住院出血并发症。
