Key result
Ticagrelor plus aspirin was associated with a 43% lower risk of cardiovascular death (HR 0.57) and a 42% lower risk of all-cause death (HR 0.58) compared to clopidogrel plus aspirin in elderly patients with acute myocardial infarction.
Why the study?
Data on the efficacy and safety of potent P2Y12 inhibitors in elderly Asian populations after acute coronary syndrome were limited.
Does ticagrelor plus aspirin reduce major adverse cardiovascular events, mortality, and net adverse clinical events compared to clopidogrel plus aspirin in elderly Asian patients after AMI and PCI?
Cohort (n=14,715)
Yes
Does ticagrelor plus aspirin reduce major adverse cardiovascular events, mortality, and net adverse clinical events compared to clopidogrel plus aspirin in elderly Asian patients after AMI and PCI?
Hazard Ratio: 0.57 (95% CI 0.38–0.85)
p-value: p=0.006
In elderly Asian patients with AMI undergoing PCI, ticagrelor plus aspirin significantly reduced all-cause mortality and net adverse clinical events compared to clopidogrel plus aspirin, without increasing major bleeding.
Should not yet change DAPT practice in elderly AMI; leaves open RCT confirmation of mortality benefit.
Background Current guidelines recommend potent P2Y12 inhibitors for patients after acute coronary syndrome. However, the data on the efficacy and safety of potent P2Y12 inhibitors in elderly Asian populations was limited. We aimed to investigate the major adverse cardiovascular events (MACE), bleeding events, and net adverse clinical events (NACE) with ticagrelor and clopidogrel in Taiwanese patients aged 65 and older after acute myocardial infarction (AMI). Methods This retrospective population-based cohort study was conducted using data from the National Health Insurance Research Database. The AMI patients aged ≥65 years who underwent percutaneous coronary intervention (PCI) and survived after 1 month were included. The patients were separated into 2 cohorts depending on the type of dual antiplatelet therapy (DAPT) they received: ticagrelor plus aspirin (T + A) or clopidogrel plus aspirin (C + A). We used inverse probability of treatment weighting to balance the difference between these 2 study groups. The outcome included all-cause mortality, MACE (cardiovascular death, nonfatal ischemic stroke, and nonfatal myocardial infarction), intracerebral hemorrhage, major bleeding, and NACE which is composed of cardiovascular death, ischemic and hemorrhagic events. The follow-up period was up to 12 months. Results From 2013 to 2017, a total of 14,715 patients who met the eligibility criteria were separated into 2 groups: 5,051 for T + A and 9,664 for C + A. Compared to patients with C + A, patients who received T + A had a lower risk of cardiovascular death and all-cause death, with an adjusted HR of 0.57 [95% confidence interval (CI), 0.38–0.85, p = 0.006] and 0.58 (95% CI 0.45–0.74, p < 0.001), respectively. No differences were found in MACE, intracranial and major bleeding between the 2 groups. In addition, the patients with T + A had a lower risk of NACE with an adjusted HR of 0.86 (95% CI 0.74–1.00, p = 0.045) Conclusion Among elderly AMI patients receiving DAPT after successful PCI, ticagrelor was a more favorable P2Y12 inhibitor than clopidogrel because of lowering the risk of death and NACE without increasing the risk of severe bleeding. Ticagrelor is an effective and safe P2Y12 inhibitor in Asian elderly survivors after PCI.
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Yeh et al. (2023) conducted a cohort in Acute myocardial infarction (n=14,715). Ticagrelor plus aspirin vs. Clopidogrel plus aspirin was evaluated on Cardiovascular death (HR 0.57, 95% CI 0.38-0.85, p=0.006). Ticagrelor plus aspirin was associated with a 43% lower risk of cardiovascular death (HR 0.57) and a 42% lower risk of all-cause death (HR 0.58) compared to clopidogrel plus aspirin in elderly patients with acute myocardial infarction.
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