Key result
In Korean patients with acute myocardial infarction without high bleeding risk, ticagrelor did not significantly increase the risk of in-hospital TIMI major bleeding compared to clopidogrel (OR 1.436).
Why the study?
Ticagrelor increases bleeding risk compared to clopidogrel in East Asian patients, but its clinical benefits in acute myocardial infarction patients without high bleeding risk remain unknown.
Does ticagrelor improve clinical outcomes or increase bleeding compared to clopidogrel in Korean AMI patients without high bleeding risk?
Cohort (n=7,348)
Yes
Does ticagrelor improve clinical outcomes or increase bleeding compared to clopidogrel in Korean AMI patients without high bleeding risk?
In Korean AMI patients undergoing PCI, ticagrelor showed similar MACE rates to clopidogrel, and excluding patients with high bleeding risk can reduce in-hospital bleeding complications associated with ticagrelor.
May support ticagrelor in selected Korean AMI patients without high bleeding risk; leaves open need for randomized confirmation.
BACKGROUND: Although ticagrelor is known to increase the bleeding risk compared to clopidogrel in East Asian patients, its clinical benefits in patients with acute myocardial infarction (AMI) without high bleeding risk (HBR) remains unknown. METHODS: A total of 7,348 patients who underwent successful percutaneous coronary intervention (PCI) from the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), between November 2011 and December 2015, were divided into two groups according to the Academic Research Consortium for HBR criteria (KAMIR-HBR, 2,469 patients; KAMIR-non HBR, 4,879 patients). We compared in-hospital major adverse cardiovascular events (MACEs, defined as a composite of cardiac death, non-fatal myocardial infarction, or stroke), and the thrombolysis in myocardial infarction (TIMI) major bleeding between ticagrelor and clopidogrel in the KAMIR-HBR and the KAMIR-non HBR groups, respectively. No differences were observed in the cumulative incidences of in-hospital and 6-month MACEs between ticagrelor and clopidogrel in both groups. CONCLUSIONS: The bleeding risk of ticagrelor was attenuated in Korean patients with AMI without HBR. Appropriate patient selection could reduce in-hospital bleeding complications associated with ticagrelor in Korean patients with AMI who underwent successful PCI.
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Park et al. (2021) conducted a cohort in Acute Myocardial Infarction (n=7,348). Ticagrelor vs. Clopidogrel was evaluated on In-hospital TIMI major bleeding (KAMIR-non HBR group) (OR 1.436, 95% CI 0.722-2.855, p=0.303). In Korean patients with acute myocardial infarction without high bleeding risk, ticagrelor did not significantly increase the risk of in-hospital TIMI major bleeding compared to clopidogrel (OR 1.436).
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