Efficacy of clopidogrel and ticagrelor under NT-proBNP in hospitalized ST-elevation acute coronary syndrome patients on percutaneous coronary intervention: CCC-ACS Project Analysis.

Abstract

BACKGROUND:

Risk stratification with specific biomarkers is proposed for tailored P2Y12 inhibitor therapy in patients with STEMI.

METHODS:

This nationwide registry and quality improvement study is from November 1, 2014, to June 30, 2017. In total, 11,512 STEMI patients received aspirin and P2Y12 receptor inhibitor (clopidogrel or ticagrelor) and underwent PCIs in hospitals. Of the patients, 2992 were prescribed ticagrelor and 8520 clopidogrel. The primary effectiveness outcome was major adverse cardiovascular and cerebrovascular events (MACCE: cardiac death, myocardial infarction, stent thrombosis, in-hospital ischemic stroke). The primary safety outcome was in-hospital major bleeding.

RESULTS:

MACCE incidence was lower in the ticagrelor group than in the clopidogrel group (0.8% versus 1.2%; P=0.046), but under different NT-proBNP levels, cumulative hazards of MACCE were without statistical significance. Bleeding rates were higher in the ticagrelor group than in the clopidogrel group (all bleeding: 9.9% versus 6.9%, P<0.001; major bleeding: 4.0% versus 2.7%, P<0.001). The higher cumulative hazard of bleeding could be identified in the Kaplan-Meier curves. In the multivariate analysis, ticagrelor increased bleeding events, compared with clopidogrel, at NT-proBNP >1800 ng/L patients (all bleeding: HR 1.46; 95%CI, 1.07-2.01; major bleeding: HR 1.68, 95%CI, 1.03-2.74), but a low effect was found in those with lower NT-proBNP level. Subgroup analyses show that ticagrelor increased major bleeding in patients with left ventricular ejection fraction (LVEF) <0.50 (HR 3.29; 95% CI 1.61-6.74) (interaction p=0.03).

CONCLUSION:

We found that ticagrelor, compared with clopidogrel, increased bleeding complications in hospitalized patients with NT-proBNP>1800 ng/L, especially in patients with EF < 0.50.

• Authors: Xin Zhao, Guannan Ai, Miaohan Qiu, Xiaozeng Wang, Lei Zhang, Xiaoxu Yang, Yifei Liu, Pei Xu, Jiyuan Zhang, Chonghuai Gu, Mengge Zhou, Yongchen Hao, Dong Zhao, Yaling Han, CCC investigators
• Journal: International journal of cardiology (Int J Cardiol) Vol. 310 Pg. 1-8 (07 01 2020) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 32307186 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier B.V. All rights reserved.

Chemical References

• Peptide Fragments
• Platelet Aggregation Inhibitors
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• Clopidogrel
• Ticagrelor

Topics

• Acute Coronary Syndrome (diagnosis, drug therapy)
• Clopidogrel (adverse effects)
• Humans
• Natriuretic Peptide, Brain
• Peptide Fragments
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (adverse effects)
• ST Elevation Myocardial Infarction (diagnostic imaging, drug therapy)
• Stroke Volume
• Ticagrelor (adverse effects)
• Treatment Outcome
• Ventricular Function, Left