Key result
Ticagrelor shows no difference in bleeding or MACE versus clopidogrel in suspected chronic coronary syndrome.
Why the study?
The potential benefit of potent platelet inhibition in patients with chronic coronary syndrome undergoing PCI has been discussed, but the comparative effects of ticagrelor versus clopidogrel remained unclear.
Does ticagrelor reduce bleeding complications or MACE compared to clopidogrel in patients with suspected chronic coronary syndrome referred for coronary angiography?
Cohort (n=1,003)
Does ticagrelor reduce bleeding complications or MACE compared to clopidogrel in patients with suspected chronic coronary syndrome referred for coronary angiography?
In real-world patients with suspected CCS referred for angiography, a potent P2Y12 inhibition strategy with ticagrelor showed similar rates of bleeding and MACE compared to clopidogrel.
Similar bleeding/MACE rates with ticagrelor versus clopidogrel in suspected CCS; hypothesis-generating and leaves open optimal P2Y12 selection.
INTRODUCTION: Potential benefit with potent platelet inhibition in patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI) has been discussed. The aim of this study was to compare a potent P2Y12 inhibition strategy using ticagrelor with clopidogrel in CCS patients referred for coronary angiography (CA) and PCI if feasible. METHODS: In this retrospective real-world study, patients referred for outpatient CA due to suspected CCS were included. To adjust for group differences, a propensity score reflecting the probability of being treated with ticagrelor was calculated and added to the logistic regression outcome model. RESULTS: In total, 1,003 patients were included in the primary analysis (577 treated with clopidogrel and 426 with ticagrelor). Among clopidogrel-treated patients, 132 (22.9%) experienced a bleeding complication compared with 93 (21.8%) among ticagrelor-treated patients, with no significant difference between the groups (p = 0.70). There was no difference in bleeding severity. Furthermore, we observed no statistically significant difference in major adverse cardiovascular events (MACE [death, stent thrombosis, myocardial infarction, or stroke]) (1.2% vs. 2.3%, p = 0.17). A subgroup analysis restricted to patients undergoing PCI ad hoc displayed a similar pattern. Also, patients undergoing CA without PCI ad hoc frequently experienced a bleeding complication, with no difference between the two treatments (21.0% vs. 17.3%, p = 0.27). Propensity score adjusted analyses confirmed the results. DISCUSSION: In patients with CCS referred for CA and PCI if feasible, a more potent P2Y12 inhibition strategy with ticagrelor was not associated with bleeding complications or MACE compared with clopidogrel.
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Träff et al. (2022) conducted a cohort in Suspected chronic coronary syndrome (n=1,003). Ticagrelor vs. Clopidogrel was evaluated on Bleeding complication (p=0.70). Ticagrelor was not associated with a significant difference in bleeding complications (21.8% vs 22.9%, p=0.70) or MACE compared with clopidogrel in patients with suspected chronic coronary syndrome.
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