Why the study?
Percutaneous treatment of coronary bifurcation lesions carries a potentially higher risk of ischemic events than nonbifurcation lesions, necessitating further optimization of dual antiplatelet therapy.
Does ticagrelor combined with aspirin reduce major adverse cardiovascular events in patients with coronary bifurcation lesions undergoing PCI compared to clopidogrel combined with aspirin?
Does ticagrelor combined with aspirin reduce major adverse cardiovascular events in patients with coronary bifurcation lesions undergoing PCI compared to clopidogrel combined with aspirin?
Ticagrelor is associated with a lower risk of MACE and MI compared to clopidogrel in patients undergoing PCI for coronary bifurcation lesions, without an increased risk of major bleeding.
May inform antiplatelet selection for bifurcation PCI; hypothesis-generating and leaves open need for RCTs.
BACKGROUND: Percutaneous treatment of coronary bifurcation lesions can potentially lead to higher risk of ischemic events than the nonbifurcation ones, thus calling for further optimization of dual antiplatelet therapy (DAPT). This study aimed to compare the clinical outcomes from ticagrelor and clopidogrel in bifurcation lesions patients undergoing percutaneous coronary intervention (PCI). METHODS: We performed a retrospective cohort study in patients with coronary bifurcation lesions. A total of 553 patients discharged on ticagrelor or clopidogrel combined with aspirin were recruited for 1-year follow-up. The incidences of primary endpoint (major adverse cardiovascular event [MACE]: a composite of cardiac death, myocardial infarction [MI] or stroke), secondary endpoints (the individual component of the primary endpoint or definite/probable stent thrombosis), and major bleeding (Bleeding Academic Research Consortium [BARC]≥3 bleeding events) were evaluated. To minimize the selection bias, a propensity score-matched population analysis was also conducted. RESULTS: The risks of both primary endpoint (8.15% and 12.01% for the ticagrelor and clopidogrel groups, respectively; adjusted hazards ratio [HR]: 0.488, 95% confidence interval [CI]: 0.277-0.861, P=0.013) and MI (4.44% and 8.48% for the ticagrelor and clopidogrel groups, respectively; adjusted HR: 0.341, 95% CI: 0.162-0.719, P=0.005) were significantly reduced in the ticagrelor group as compared with those of the clopidogrel counterpart, whereas the risk of major bleeding was comparable (2.96% and 2.47% for the ticagrelor and clopidogrel groups, respectively; adjusted HR: 0.972, 95% CI: 0.321-2.941, P=0.960). Propensity score-matched analysis confirmed such findings. CONCLUSIONS: For patients with bifurcation lesions after PCI, ticagrelor treatment shows lower MACE and MI rates than the clopidogrel one, along with comparable major bleeding.
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Zheng et al. (2019) studied this question.
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