Key result
Ticagrelor significantly inhibited platelet aggregation and reduced peri-PCI myocardial injury compared to clopidogrel in patients with unstable angina, but did not reduce 12-month major adverse cardiac and cerebral events and increased bleeding.
Why the study?
The comparative effects of ticagrelor and clopidogrel on platelet inhibition, cardiovascular prognosis, and bleeding in patients with unstable angina remained to be evaluated.
Does ticagrelor improve platelet inhibition and cardiovascular prognosis compared to clopidogrel in patients with unstable angina undergoing PCI?
Cohort (n=422)
No
Does ticagrelor improve platelet inhibition and cardiovascular prognosis compared to clopidogrel in patients with unstable angina undergoing PCI?
Absolute Event Rate: 18.23% vs 27.86%
p-value: p=<0.001
In patients with unstable angina undergoing PCI, ticagrelor provided stronger platelet inhibition and reduced peri-procedural myocardial injury compared to clopidogrel, but did not improve 12-month MACE and increased bleeding events.
Ticagrelor was associated with greater platelet inhibition than clopidogrel post-PCI for unstable angina; leaves open effects on prognosis or bleeding.
Objective To compare the effect of ticagrelor and clopidogrel on platelet inhibition and cardiovascular prognosis and bleeding in patients with unstable angina. Methods Patients diagnosed as unstable angina and undergoing successful PCI were selected from January 2016 to December 2018. Totally 212 patients received ticagrelor (90mg twice daily) and 210 received clopidogrel (75mg daily). Thrombo-elastography (TEG) and light transmission aggregometry (LTA) were used to measure platelet aggregation rate (PAR) induced by adenosine diphosphate (ADP) and arachidonic acid (AA). High-sensitivity troponin T (hs-TnT), pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (CRP) and heart-type fatty acid binding protein(H-FABP)were measured to assess myocardium injury peri-PCI. Patients were followed up in hospital and 12 months after discharge for cardiovascular prognosis and bleeding events. Results There were no significant differences in clinical characteristics between the two groups. Compared with clopidogrel, PAR in ticagrelor group was inhibited more significantly (P < 0.001). Hs-TnT, NT-proBNP, CRP, and h-FABP elevated post PCI in both groups (P < 0.05 vs. Pre-PCI in each group), of which hs-TnT (P < 0.001) and h-FABP (P < 0.001) in clopidogrel group elevated more significantly. Both MACE in hospital and at 12-months follow up showed no significant difference between the two groups. Total bleeding events were increased in hospital in ticagrelor group (P < 0.05). Both minor bleeding and total bleeding were significantly elevated at 12-month follow up in ticagrelor group (P < 0.05). Conclusions Ticagrelor was effective in platelet suppression than clopidogrel and reduced peri-PCI myocardial injury in patients with unstable angina. However, ticagrelor showed no advantages in reducing in hospital and 12-months MACE and increased in hospital and 12-months bleeding events.
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Lin et al. (2021) conducted a cohort in Unstable angina (n=422). Ticagrelor vs. Clopidogrel 75mg daily was evaluated on Platelet aggregation rate (PAR) induced by ADP at 3 days by TEG (%) (p=<0.001). Ticagrelor significantly inhibited platelet aggregation and reduced peri-PCI myocardial injury compared to clopidogrel in patients with unstable angina, but did not reduce 12-month major adverse cardiac and cerebral events and increased bleeding.
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