Efficacy and safety of ticagrelor versus clopidogrel with different dosages in acute coronary syndrome patients with high GRACE and CRUSADE scores

OBJECTIVE: To investigate the efficacy and safety of ticagrelor and different dosages of clopidogrel after acute coronary syndrome. METHODS: We compared different antiplatelet strategies for the prevention of cardiovascular events in 1939 patients admitted to the hospital with an acute coronary syndrome undergoing percutaneous coronary intervention (PCI). RESULTS: At 24 months, a survival analysis showed that ticagrelor and double-dose clopidogrel decreased the incidence of MACCE (a composite of all-cause death, myocardial infarction (MI), target vessel revascularization and stroke) (p < 0.001, p = 0.012, respectively). Although double-dose clopidogrel obviously increased the risk of major bleeding (p < 0.001), a similar result was not observed in the ticagrelor group (p = 0.398). These two stronger antiplatelet strategies also decreased the incidence of myocardial infarction (p = 0.004 and 0.045, respectively). The advantages of ticagrelor are also evident in the endpoints of all cause death and target vessel revascularization. The NACCE (a composite of all-cause death, MI, stroke and major bleeding) rate was also reduced in the ticagrelor group (p = 0.004). CONCLUSIONS: In PCI patients with a high ischemic and bleeding risk, the ticagrelor antiplatelet strategy significantly reduced the MACCE rate without increasing the risk of major bleeding. A decreased MACCE rate was also observed in patients administered the double dosage of clopidogrel, but the bleeding risk was increased compared with the control group.