Abstract Background Malnutrition is associated with poor prognosis in patients with acute coronary syndrome; however, it remains uncertain whether these patients benefit from more intensive antiplatelet therapy. Purpose This study aims to investigate the impact of ticagrelor compared with clopidogrel on the prognosis of patients with acute myocardial infarction (AMI) and malnutrition. Methods This retrospective cohort study sourced from 82 hospitals from January 2010 to March 2024. Patients with AMI who received aspirin plus clopidogrel or ticagrelor were included and divided into: a normal nutrition group Prognostic Nutritional Index score (PNI) 38 and a moderate-severe malnutrition group (PNI = 38). Propensity score matching (PSM) was employed to balance covariates. The primary endpoint was net adverse clinical events (NACE), defined as the composite endpoint of cardiac death, recurrent myocardial infarction (MI), ischemic stroke and Major bleeding events within one year. Results Among the 27,931 patients at normal nutrition group, there were 5,978 patients in the ticagrelor group. PSM yielded 5,655 well-matched pairs. It was observed that compared with the clopidogrel group, patients in the ticagrelor group had a lower risk of recurrent MI (aHR, 0.565; 95%CI, 0.471-0.678, P 0.001) but a higher risk of Major bleeding events (aHR, 2.138; 95%CI, 1.697-2.694; P 0.001). Among the 19,426 patients at moderate-severe malnutrition group, there were 3,962 patients in the ticagrelor group. PSM yielded 3,823 well-matched pairs. The results showed that there was a lower risk of cardiac death (aHR, 0.633; 95%CI, 0.487-0.822, P = 0.001), recurrent MI(aHR, 0.63; 95%CI, 0.508-0.782; P 0.001), and NACE (aHR, 0.805; 95%CI, 0.711-0.911; P = 0.001) in the ticagrelor group compared with the clopidogrel group. However, there was no significant difference in the risk of major bleeding events between the two groups (aHR, 1.225; 95%CI, 0.981-1.529; P = 0.073). Conclusions In patients with AMI and malnutrition, ticagrelor significantly reduced the risks of cardiac death, recurrent MI, and NACE compared with clopidogrel, without increasing the risk of major bleeding events. In contrast, while ticagrelor also reduces recurrent MI in AMI and well-nourished patients, it is associated with a higher risk of major bleeding events. These findings suggest that ticagrelor may be particularly beneficial for AMI patients with malnutrition, highlighting the importance of individualized antiplatelet therapy based on nutritional status.
Hu et al. (Sat,) studied this question.