Wu Hui, Jia Shaobin
Heart Centre & Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
Clinical Medical College, Ningxia Medical University, Yinchuan, Ningxia, China.
J Clin Pharmacol. 2023 Jul;63(7):776-783. doi: 10.1002/jcph.2239. Epub 2023 May 8.
This study was conducted to compare the efficacy and safety of ticagrelor and clopidogrel in patients with acute coronary syndrome (ACS) treated with primary percutaneous coronary intervention (PPCI). A total of 3528 consecutive patients with ACS treated with PPCI were divided into the ticagrelor and clopidogrel groups based on their dual antiplatelet therapy regimen at hospital discharge. Patient follow-up visits were completed 1, 6, and 12 months after PPCI treatment. Major adverse cardiac events (MACEs) and Bleeding Academic Research Consortium (BARC) bleeding events were assessed in both groups. In total, 2501 cases were included in the ticagrelor group, and 817 cases were included in the clopidogrel group. The incidence of MACEs was lower in the ticagrelor group than in the clopidogrel group (P < .05). The ticagrelor group had lower incidence of all-cause death and cardiac death compared with the clopidogrel group, and the difference was significant (P < .05). The incidences of study end points, including recurrent myocardial infarction and repeat revascularization, were not significantly different between the groups (P > .05). The incidences of BARC total and major bleeding events were not significantly different between the groups (P > .05). However, the incidences of BARC type 1 and 2 bleeding events were lower in the ticagrelor group than in the clopidogrel group (P < .05). The multivariate Cox regression analysis suggested that ticagrelor could decrease all-cause death compared with clopidogrel (P = .021). In patients with ACS treated with PPCI, ticagrelor could significantly reduce the risk of MACEs compared with clopidogrel, without increasing the risk of bleeding.
本研究旨在比较替格瑞洛和氯吡格雷在接受直接经皮冠状动脉介入治疗（PPCI）的急性冠状动脉综合征（ACS）患者中的疗效和安全性。共有3528例接受PPCI治疗的连续ACS患者根据出院时的双联抗血小板治疗方案分为替格瑞洛组和氯吡格雷组。在PPCI治疗后1、6和12个月完成患者随访。评估两组的主要不良心脏事件（MACE）和出血学术研究联盟（BARC）出血事件。替格瑞洛组共纳入2501例，氯吡格雷组纳入817例。替格瑞洛组的MACE发生率低于氯吡格雷组（P <.05）。与氯吡格雷组相比，替格瑞洛组的全因死亡和心源性死亡发生率更低，差异有统计学意义（P <.05）。两组间包括复发性心肌梗死和再次血运重建在内的研究终点发生率无显著差异（P >.05）。两组间BARC总出血事件和大出血事件的发生率无显著差异（P >.05）。然而，替格瑞洛组的BARC 1型和2型出血事件发生率低于氯吡格雷组（P <.05）。多因素Cox回归分析表明，与氯吡格雷相比，替格瑞洛可降低全因死亡风险（P = 0.021）。在接受PPCI治疗的ACS患者中，与氯吡格雷相比，替格瑞洛可显著降低MACE风险，且不增加出血风险。
