Akyuz Sukru, Calik Ali Nazmi, Yaylak Baris, Onuk Tolga, Eren Semih, Kolak Zeynep, Mollaalioglu Feyza, Durak Furkan, Cetin Mustafa, Tanboga Ibrahim Halil
Department of Cardiology, Okan University Faculty of Medicine, Istanbul, Turkey.
Department of Cardiology, University of Health Sciences, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Am J Cardiol. 2024 Jan 1;210:241-248. doi: 10.1016/j.amjcard.2023.10.046. Epub 2023 Oct 22.
Current guidelines recommend individualizing the choice and duration of P2Y inhibitor therapy based on the trade-off between bleeding and ischemic risk. However, whether a potent P2Y inhibitor (ticagrelor) or a less potent one (clopidogrel) is more appropriate in patients with acute coronary syndrome (ACS) in the setting of high bleeding or ischemic risk is not clear. The study aimed to compare the clinical outcomes of clopidogrel and ticagrelor in patients with ACS at high bleeding or ischemic risk. A total of 5,713 patients with ACS were included in this retrospective study. The Cox proportional hazard regression model was adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The primary clinical outcome was all-cause death. Secondary outcomes included in-hospital death, ACS, target vessel revascularization, stent thrombosis, stroke, or clinically significant or major bleeding. The median follow-up duration was 53.6 months. After multivariable Cox model using an inverse probability weighted approach, all-cause death in the overall population and subgroups of patients at high bleeding risk, and/or at high ischemic risk were not significantly different between clopidogrel and ticagrelor. Rates for secondary outcomes were also similar between the groups. In conclusion, ticagrelor and clopidogrel are associated with comparable clinical outcomes in patients with ACS irrespective of bleeding and ischemic risk.
当前指南建议根据出血风险和缺血风险之间的权衡来个体化选择P2Y抑制剂治疗及其疗程。然而，在出血风险或缺血风险较高的急性冠状动脉综合征（ACS）患者中，强效P2Y抑制剂（替格瑞洛）或效力较弱的P2Y抑制剂（氯吡格雷）哪种更合适尚不清楚。本研究旨在比较氯吡格雷和替格瑞洛在出血风险或缺血风险较高的ACS患者中的临床结局。这项回顾性研究共纳入了5713例ACS患者。采用逆概率加权法对Cox比例风险回归模型进行校正，以减少治疗选择偏倚。主要临床结局为全因死亡。次要结局包括院内死亡、ACS、靶血管血运重建、支架血栓形成、卒中或具有临床意义的出血或大出血。中位随访时间为53.6个月。在使用逆概率加权法的多变量Cox模型中，氯吡格雷和替格瑞洛在总体人群以及高出血风险患者亚组和/或高缺血风险患者亚组中的全因死亡无显著差异。两组的次要结局发生率也相似。总之，无论出血和缺血风险如何，替格瑞洛和氯吡格雷在ACS患者中具有相似的临床结局。
