Key result
Initial ticagrelor therapy showed no significant difference in the risk of major adverse cardiac and cerebrovascular events compared to clopidogrel in Korean patients with acute myocardial infarction and renal impairment (HR 0.810).
Why the study?
Guidelines recommend potent P2Y12 inhibitors over clopidogrel in AMI, but their net benefit in East Asian patients with renal impairment remains uncertain.
Does an initial ticagrelor strategy improve ischemic or bleeding outcomes compared to clopidogrel in East Asian patients with acute myocardial infarction and renal dysfunction?
Cohort (n=7,590)
Yes
Does an initial ticagrelor strategy improve ischemic or bleeding outcomes compared to clopidogrel in East Asian patients with acute myocardial infarction and renal dysfunction?
Hazard Ratio: 0.81 (95% CI 0.581–1.128)
p-value: p=0.212
In East Asian patients with acute myocardial infarction and renal impairment, an initial strategy of ticagrelor versus clopidogrel showed no significant difference in 1-year ischemic or bleeding outcomes, though high rates of switching from ticagrelor to clopidogrel complicate interpretation.
No advantage for ticagrelor over clopidogrel in East Asian AMI with renal impairment; challenges guideline preference for potent P2Y12 inhibitors in this group.
Contemporary international guidelines recommend potent P2Y12 inhibitors over clopidogrel in patients with acute myocardial infarction (AMI); however, their net benefit in East Asian patients with renal impairment remains uncertain.In this nationwide propensity scoreadjusted analysis of 7,590 Korean patients with AMI and renal impairment, initial ticagrelor and clopidogrel strategies showed no significant differences in ischemic or clinically relevant bleeding outcomes at 1 year.Findings were consistent across post-discharge periods and renal function strata.These results warrant cautious interpretation within a treatment-policy framework and highlight the need for prospective studies assessing exposure and adherence in this high-risk population.
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Oh et al. (2026) conducted a cohort in Acute myocardial infarction with renal impairment (n=7,590). Ticagrelor vs. Clopidogrel was evaluated on Major adverse cardiac and cerebrovascular events (MACCEs) (HR 0.810, 95% CI 0.581-1.128, p=0.212). Initial ticagrelor therapy showed no significant difference in the risk of major adverse cardiac and cerebrovascular events compared to clopidogrel in Korean patients with acute myocardial infarction and renal impairment (HR 0.810).
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