Why the study?
Real-world evidence evaluating the clinical impacts of ticagrelor versus clopidogrel on East Asian diabetic patients with ACS has rarely been investigated.
Does ticagrelor reduce all-cause mortality compared to clopidogrel in Taiwanese diabetic patients with acute coronary syndrome undergoing successful revascularization?
Does ticagrelor reduce all-cause mortality compared to clopidogrel in Taiwanese diabetic patients with acute coronary syndrome undergoing successful revascularization?
In a real-world cohort of Taiwanese diabetic patients with ACS undergoing successful revascularization, ticagrelor significantly reduced 24-month all-cause mortality compared to clopidogrel without increasing re-hospitalization.
Ticagrelor was associated with better survival than clopidogrel in East Asian diabetic ACS; extends trial data but leaves open need for confirmatory RCTs.
Although previous clinical trials demonstrated that ticagrelor could reduce cardiovascular events and mortality versus clopidogrel in patients with acute coronary syndrome (ACS), the real-world evidence of its clinical impacts on East Asian Diabetic population has rarely been investigated.Between November 2013 and June 2015, 1534 patients were recruited into the Acute Coronary Syndrome-Diabetes Mellitus Registry of the Taiwan Society of Cardiology (TSOC ACS-DM registry). After propensity score matching, a total of 730 patients undergoing successful revascularization and discharged on ticagrelor (N = 365) or clopidogrel (N = 365) were analyzed. The primary and secondary endpoints were all-cause mortality and re-hospitalization, respectively. The all-cause death associated with ticagrelor vs clopidogrel was 3.6% vs 7.4% (adjusted hazard ratio (HR) 0.34 [0.15-0.80]; P = .0138) at 24 months. The re-hospitalization rate at 24 months was 38.9% vs 39.2% (P = .3258).For diabetic patients with ACS, ticagrelor provided better survival benefit than clopidogrel without an increase of re-hospitalization in 24 months after successful percutaneous coronary intervention. This study in real-world circumstance provided valuable complementary data to externally validate platelet inhibition and patient outcomes (PLATO) finding especially in Asian diabetic population.
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Wang et al. (2020) studied this question.
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