Key result
Ticagrelor DAPT shows no benefit over clopidogrel for MACCE in ACS and CKD.
Why the study?
The impact of ticagrelor-based dual antiplatelet therapy on acute coronary syndrome in patients with chronic kidney disease remains unclear.
Does ticagrelor-based DAPT improve ischemic and bleeding outcomes compared to clopidogrel-based DAPT in ACS patients with CKD after new-generation DES implantation?
Cohort (n=1,067)
Yes
Does ticagrelor-based DAPT improve ischemic and bleeding outcomes compared to clopidogrel-based DAPT in ACS patients with CKD after new-generation DES implantation?
Hazard Ratio: 0.95 (95% CI 0.56–1.61)
Absolute Event Rate: 7.8% vs 8.4%
p-value: p=0.855
Ticagrelor-based DAPT may reduce ischemic events without increasing bleeding compared to clopidogrel in ACS patients with non-ESRD CKD, though overall effects vary by CKD stage.
Does not support ticagrelor over clopidogrel for MACCE reduction in ACS-CKD; leaves open stage-specific effects in non-ESRD subgroups.
Background: The impact of ticagrelor-based dual antiplatelet therapy (DAPT) on acute coronary syndrome (ACS) in patients with chronic kidney disease (CKD) remains unclear. Methods: Data on a total of 1,067 ACS patients with CKD including end-stage renal disease (ESRD) who underwent new-generation drug-eluting stent implantation were extracted from a multicenter registry. This study aimed to compare outcomes of patients treated with ticagrelor- (n = 449) and those treated with clopidogrel-based (n = 618) DAPT. Outcomes of interest included major adverse cardiac and cerebrovascular events (MACCEs) and bleeding (Bleeding Academic Research Consortium grade 3 or 5) at 12 months. Propensity-score matching (346 pairs) analysis was performed. Results: The patients with ESRD showed the highest MACCE and bleeding rates (P < 0.001). There was no difference in the rate of MACCEs between the treatment groups (7.8% vs. 8.4%; hazard ratio [HR] = 0.95, 95% confidence interval [CI] = 0.56–1.61, P = 0.855); however, a trend toward an increased bleeding rate was observed in the ticagrelor-based DAPT group (6.8% vs. 3.8%, HR = 1.84, 95% CI = 0.93–3.63, P = 0.079). Among patients with CKD stage III/IV but without ESRD (277 pairs), the ticagrelor-based DAPT group showed a reduced MACCE rate (3.6% vs. 8.7%, HR = 0.41, 95% CI = 0.19–0.86, P = 0.018) and a similar bleeding rate (5.1% vs. 3.2%, HR = 1.61, 95% CI = 0.70–3.71, P = 0.267), compared with those of the clopidogrel-based DAPT group. Conclusion: The effects of ticagrelor-based DAPT on ischemic and bleeding outcomes of ACS patients with CKD varied according to CKD stage; in ACS patients with CKD without ESRD, ticagrelor-based DAPT reduced MACCE risk without increasing bleeding risks, relative to those observed with clopidogrel-based DAPT.
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Roh et al. (2022) conducted a cohort in Acute Coronary Syndrome with Chronic Kidney Disease (n=1,067). Ticagrelor-based dual antiplatelet therapy vs. Clopidogrel-based dual antiplatelet therapy was evaluated on Major adverse cardiac and cerebrovascular events (MACCEs) at 12 months (HR 0.95, 95% CI 0.56-1.61, p=0.855). In patients with acute coronary syndrome and chronic kidney disease, ticagrelor-based dual antiplatelet therapy did not significantly reduce major adverse cardiac and cerebrovascular events compared to clopidogrel (HR 0.95).
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