Dang Dan, Li Jing, Li Yi, Qiu Miaohan, Wang Bin, Qi Bin, Han Yaling
Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China.
The Department of Cardiology, Dalian Medical University, Dalian, China.
Res Pract Thromb Haemost. 2025 Aug 7;9(6):102997. doi: 10.1016/j.rpth.2025.102997. eCollection 2025 Aug.
The selection of P2Y12 inhibitors for acute coronary syndrome patients after percutaneous coronary intervention (PCI) remains controversial among East Asian patients.
This study aimed to identify the optimal P2Y12 inhibitor selection for the East Asian population carrying loss-of-function (LOF) alleles based on the Global Registry of Acute Coronary Events (GRACE) score.
Between March 2016 and March 2019, a cohort of 8683 patients diagnosed with acute coronary syndrome who survived PCI were enrolled in this study. All patients carried the LOF allele and could calculate GRACE scores. The primary outcome was ischemic events (cardiac death, nonfatal myocardial infarction, and ischemic stroke) within 12 months. Secondary outcomes included the components of the primary outcome, all-cause mortality, Bleeding Academic Research Consortium (BARC) types 2, 3, and 5 bleeding events, and BARC types 3 and 5 bleeding events. The propensity score matching method was used to balance the baseline characteristics of patients. The Kaplan-Meier/log-rank test was adopted for the result analysis, and Cox regression was employed for adjusting for confounding factors.
The low-risk group comprised 5496 patients (63.3%), while the intermediate- to high-risk group included 3187 patients (36.7%) in the study population stratified by GRACE scores. The follow-up results revealed that in patients at low risk, clopidogrel and ticagrelor had comparable effects in preventing ischemic events. However, ticagrelor use was associated with a higher risk of BARC types 2, 3, and 5 bleeding events (hazard ratio [HR], 2.08; 95% CI, 1.43-3.02; < .001) and BARC types 3 and 5 bleeding events (HR, 2.69; 95% CI, 1.57-4.63; < .001) compared with clopidogrel use. In patients at intermediate to high risk, ticagrelor treatment was associated with a lower risk of stroke (HR, 0.18; 95% CI, 0.04-0.82; = .026), while the risk of ischemic events or bleeding was comparable between the 2 treatment groups.
These real-world data on East Asian patients with LOF alleles suggest that GRACE risk stratification may help differentiate ischemic and bleeding risks post-PCI.
在东亚患者中，经皮冠状动脉介入治疗（PCI）后急性冠状动脉综合征患者的P2Y12抑制剂选择仍存在争议。
本研究旨在基于全球急性冠状动脉事件注册研究（GRACE）评分，为携带功能丧失（LOF）等位基因的东亚人群确定最佳的P2Y12抑制剂选择。
2016年3月至2019年3月，本研究纳入了8683例诊断为急性冠状动脉综合征且PCI术后存活的患者。所有患者均携带LOF等位基因且可计算GRACE评分。主要结局为12个月内的缺血事件（心源性死亡、非致死性心肌梗死和缺血性卒中）。次要结局包括主要结局的组成部分、全因死亡率、出血学术研究联盟（BARC）2型、3型和5型出血事件以及BARC 3型和5型出血事件。采用倾向评分匹配法平衡患者的基线特征。结果分析采用Kaplan-Meier/对数秩检验，采用Cox回归调整混杂因素。
在根据GRACE评分分层的研究人群中，低风险组包括5496例患者（63.3%），中高风险组包括3187例患者（36.7%）。随访结果显示，在低风险患者中，氯吡格雷和替格瑞洛在预防缺血事件方面效果相当。然而，与使用氯吡格雷相比，使用替格瑞洛与更高的BARC 2型、3型和5型出血事件风险（风险比[HR]，2.08；95%可信区间[CI]，1.43-3.02；P<0.001）以及BARC 3型和5型出血事件风险（HR，2.69；95%CI，1.57-4.63；P<0.001）相关。在中高风险患者中，替格瑞洛治疗与较低的卒中风险相关（HR，0.18；95%CI，0.04-0.82；P=0.026），而两个治疗组之间的缺血事件或出血风险相当。
这些关于携带LOF等位基因的东亚患者的真实世界数据表明，GRACE风险分层可能有助于区分PCI术后的缺血和出血风险。
