Yan Yufeng, Xu Haimei, Zhao Yingying, Lin Song, Zheng Yaguo
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China.
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Qinhuai District, Nanjing, 210006, Jiangsu, China.
Cardiovasc Drugs Ther. 2024 Oct 26. doi: 10.1007/s10557-024-07636-3.
The left main (LM) coronary artery disease poses high risks for its special anatomical characteristics. Optimal antiplatelet therapy is still controversial in this disease. We aimed to investigate the efficacy and safety of ticagrelor and clopidogrel in patients with stent implantation in the LM coronary artery.
We analyzed 3221 patients with stent implantation in the LM coronary artery from January 2011 to June 2022. Patients were separated into two groups: the ticagrelor group (n = 1550) and the clopidogrel group (n = 1671). Baseline data were balanced by propensity score matching. The primary endpoint was all-cause mortality, and secondary endpoints included cardiovascular death, myocardial infarction, stroke, stent thrombosis, or target vessel revascularization. The primary safety endpoint was major bleeding, defined as BARC 3, 5 bleeding.
After propensity score matching (n = 1228 in each group), ticagrelor was linked to a lower incidence of all-cause mortality compared with clopidogrel after a three-year follow-up (5.7% vs. 8.5%; HR:0.728; 95%CI:0.537-0.985, P = 0.040). Ticagrelor treatment reduced target lesion revascularization (3.3% vs. 6.4%; HR: 0.542; 95%CI: 0.371-0.791, P = 0.001) and stent thrombosis (1.6% vs. 3.7%; HR: 0.459; 95%CI: 0.271-0.776, P = 0.004). There was no significant difference in major bleeding between the two groups. Multivariate COX analysis suggested that age, heart rate, diabetes, prior myocardial infarction, hemoglobin, serum creatinine, ticagrelor, DAPT duration, LM true-bifurcation, LM stent diameters, and IVUS were independent predictive parameters of all-cause death.
Ticagrelor was associated with lower all-cause mortality and no increased risk of major bleeding compared to clopidogrel in LM stenting patients. Thus, ticagrelor can be considered a viable substitute for clopidogrel in LM disease.
左主干（LM）冠状动脉疾病因其特殊的解剖学特征而具有高风险。在这种疾病中，最佳抗血小板治疗仍存在争议。我们旨在研究替格瑞洛和氯吡格雷在LM冠状动脉支架植入患者中的疗效和安全性。
我们分析了2011年1月至2022年6月期间3221例LM冠状动脉支架植入患者。患者分为两组：替格瑞洛组（n = 1550）和氯吡格雷组（n = 1671）。通过倾向评分匹配使基线数据达到平衡。主要终点是全因死亡率，次要终点包括心血管死亡、心肌梗死、中风、支架血栓形成或靶血管血运重建。主要安全终点是大出血，定义为BARC 3、5级出血。
经过倾向评分匹配（每组n = 1228），在三年随访后，与氯吡格雷相比，替格瑞洛与较低的全因死亡率相关（5.7%对8.5%；HR：0.728；95%CI：0.537 - 0.985，P = 0.040）。替格瑞洛治疗降低了靶病变血运重建（3.3%对6.4%；HR：0.542；95%CI：0.371 - 0.791，P = 0.001）和支架血栓形成（1.6%对3.7%；HR：0.459；95%CI：0.271 - 0.776，P = 0.004）。两组大出血发生率无显著差异。多变量COX分析表明，年龄、心率、糖尿病、既往心肌梗死、血红蛋白、血清肌酐、替格瑞洛、双联抗血小板治疗持续时间、LM真性分叉、LM支架直径和血管内超声是全因死亡的独立预测参数。
在LM冠状动脉支架植入患者中，与氯吡格雷相比，替格瑞洛与较低的全因死亡率相关且大出血风险未增加。因此，在LM疾病中，替格瑞洛可被视为氯吡格雷的可行替代药物。
