Ticagrelor Versus Clopidogrel in Patients With ST-Elevation Myocardial Infarction and Elevated Platelet Counts: A Multicenter Comparative Analysis of Ischemic Outcomes.

Figures

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  Fig. 1.. Study flowchart. MACCE, major adverse cardiac and cerebrovascular event; NACE, net adverse clinical event; AMI, acute myocardial infarction; PSM, propensity score matching; BARC, Bleeding Academic Research Consortium.

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  Fig. 2.. Kaplan–Meier survival curves illustrating cumulative incidences of various 1-year clinical outcomes in propensity score-matched patients ((A) Cardiac death; (B) All-cause death; (C) MACCE; and (D) NACE). Footnotes: The curves depict 1 minus the Kaplan–Meier survival probability, representing the cumulative incidence function. The step functions are constructed based on event times within specified intervals, with risk tables displaying at-risk numbers and censoring counts positioned below the x-axis at designated time points (days: 0, 30, 60, 90, 120, 150, 180, 210, 240, 270, 300, and 360). The y-axes are standardized to a 0%–25% scale. p values were obtained through a log-rank test comparing clopidogrel to ticagrelor within a propensity score-matched cohort (n = 461 per group at baseline). The analysis employed an intention-to-treat approach, with follow-up censored at 360 days or upon event/death. Abbreviations: MACCE, major adverse cardiac and cerebrovascular event (cardiac death/non-fatal myocardial infarction/cerebral infarction); NACE, net adverse clinical event (MACCE plus BARC type 3–5 bleeding).

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  Fig. 3.. Adjusted forest plot of clinical outcomes with median follow-up time. Footnotes: The forest plot displays exploratory multivariable-adjusted HRs with 95% CIs derived from Cox proportional hazards regression models within the propensity score-matched cohort (N = 461 per group). The vertical line at HR = 1.0 indicates no difference between groups; points to the left of 1.0 favor ticagrelor, whereas those to the right favor clopidogrel. Models were adjusted for all baseline characteristics listed in Table 1 (including age, sex, Killip class, comorbidities, and complications), as well as in-hospital treatments that were significantly imbalanced after matching (primary PCI). The proportional hazards assumption was verified using Schoenfeld residuals (global p > 0.05 for all outcomes). Follow-up was censored at 12 months or at the last known vital status. MACCE: cardiac mortality, recurrent non-fatal myocardial infarction, and cerebral infarction; NACE: MACCE plus BARC type 3–5 bleeding. BARC type 3–5 refers to major bleeding events classified by the BARC.