Xi Ziwei, Qiu Zifeng, Li Jianan, Qiu Hong, Guo Tingting, Wang Yong, Zheng Jianfeng, Gao Yanan, Gao Runlin
Department of Cardiology, Coronary Artery Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, HE, China.
Peking University Health Science Center, Beijing, HE, China.
Platelets. 2022 Nov 17;33(8):1270-1278. doi: 10.1080/09537104.2022.2118250. Epub 2022 Sep 1.
The benefits of potent antithrombotic therapy usually come at the expense of a higher risk of bleeding. The efficacy and safety of ticagrelor in elderly East Asian populations remains debated due to the concerns about the imbalance of ischemic and bleeding risks. This study aimed to compare the impact of clopidogrel with ticagrelor on clinical outcomes in East Asian patients aged ≥75 years with acute coronary syndrome (ACS) using data from an institutional registry. We assessed the treatment effect of ticagrelor versus clopidogrel based on propensity scores and multivariate Cox proportional hazards models. A total of 2775 ACS patients were included, of which 235 (8.5%) were treated with ticagrelor. The primary efficacy outcome occurred in 11.9% of patients treated with ticagrelor versus 8.8% treated with clopidogrel. There was no significant association between treatment with ticagrelor and a lower risk of the primary efficacy outcome (p = .156). However, the incidences of all-cause death (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.02 to 2.79) and major bleeding (adjusted HR 2.20, 95% CI 1.06 to 4.56) were significantly higher in patients treated with ticagrelor than clopidogrel. In elderly patients with ACS from East Asia, the efficacy of clopidogrel was comparable to ticagrelor, while ticagrelor is associated with an increased risk of mortality and major bleeding.
强效抗血栓治疗的益处通常是以更高的出血风险为代价的。由于担心缺血和出血风险的不平衡，替格瑞洛在东亚老年人群中的疗效和安全性仍存在争议。本研究旨在利用机构登记数据，比较氯吡格雷与替格瑞洛对≥75岁急性冠状动脉综合征（ACS）东亚患者临床结局的影响。我们基于倾向评分和多变量Cox比例风险模型评估了替格瑞洛与氯吡格雷的治疗效果。共纳入2775例ACS患者，其中235例（8.5%）接受替格瑞洛治疗。接受替格瑞洛治疗的患者中11.9%发生主要疗效结局，而接受氯吡格雷治疗的患者中这一比例为8.8%。替格瑞洛治疗与较低的主要疗效结局风险之间无显著关联（p = 0.156）。然而，接受替格瑞洛治疗的患者全因死亡（风险比[HR] 1.69，95%置信区间[CI] 1.02至2.79）和大出血（校正HR 2.20，95% CI 1.06至4.56）的发生率显著高于接受氯吡格雷治疗的患者。在东亚老年ACS患者中，氯吡格雷的疗效与替格瑞洛相当，而替格瑞洛与更高的死亡风险和大出血风险相关。
