Ticagrelor or Clopidogrel After an Acute Coronary Syndrome in the Elderly: A Propensity Score Matching Analysis from 16,653 Patients Treated with PCI Included in Two Large Multinational Registries.

Abstract

PURPOSE:

Higher risk of bleeding with ticagrelor over clopidogrel in elderly patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) has been suggested. We assessed the incidence of major bleedings (MB), reinfarction (re-MI), and all-cause death to evaluate safety and efficacy of ticagrelor versus clopidogrel in such population.

METHODS:

Real-world registries RENAMI and BleeMACS were merged. The pooled cohort was divided into two groups, clopidogrel versus ticagrelor. Statistical analysis considered patients <75 versus ≥75 years old. Endpoints were BARC 3-5 MB, re-MI, and all-cause death at 1-year follow-up. The study included 16,653 patients (13,153 < 75 and 3500 ≥ 75 years). Ticagrelor was underused in elderly patients (16.3% versus 20.8%, P < 0.001). Using propensity score matching (PSM), two treatment groups of 1566 patients were included in the final analysis.

RESULTS:

Ticagrelor was able to prevent re-MI (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.2-0.6; P < 0.001) and all-cause death (HR, 0.60; 95% CI, 0.4-0.9; P = 0.026) irrespective of age. In patients ≥75 years, ticagrelor reduced all-cause death (HR, 0.32; 95% CI, 0.1-0.8; P = 0.012) and re-MI (HR, 0.25; 95% CI, 0.1-1.1, P = 0.072). Moreover, even with the limit of the low number of events, ticagrelor did not significantly increase the incidence of MB (HR, 1.49; 95% CI, 0.70-3.0; P = 0.257). At multiple Cox regression, age (HR, 1.03; 95% CI, 1.02-1.05; P < 0.001) resulted an independent risk factor for bleeding.

CONCLUSION:

In our study, reflecting the results from two large retrospective, real-world registries, Ticagrelor did not significantly increase MB compared with clopidogrel in elderly patients with ACS treated with PCI, while significantly improving 1-year survival. Further studies on elderly patients are suggested.

• Authors: Matteo Bianco, Alessandro Careggio, Carlo Alberto Biolè, Giorgio Quadri, Alicia Quiros, Sergio Raposeiras-Roubin, Emad Abu-Assi, Tim Kinnaird, Albert Ariza-Solè, Christoph Liebetrau, Sergio Manzano-Fernàndez, Giacomo Boccuzzi, Jose P S Henriques, Amanda Spirito, Christian Templin, Stephen B Wilton, Lazar Velicki, Luis Correia, Andrea Rognoni, Fabrizio Ugo, Ivàn Nunez-Gil, Toshiharu Fujii, Alessandro Durante, Xiantao Song, Tetsuma Kawaji, Dimitrios Alexopoulos, Zenon Huczek, Josè Ramòn Gonzàlez Juanatey, Shao-Ping Nie, Masa-Aki Kawashiri, Umberto Morbiducci, Alberto Dominguez-Rodriguez, Paola Destefanis, Alessia Luciano, Gaetano Maria De Ferrari, Ferdinando Varbella, Laura Montagna, Fabrizio D'Ascenzo, Enrico Cerrato
• Journal: Cardiovascular drugs and therapy (Cardiovasc Drugs Ther) Vol. 35 Issue 6 Pg. 1171-1182 (12 2021) ISSN: 1573-7241 [Electronic] United States
• PMID: 34224052 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021. Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticagrelor

Topics

• Acute Coronary Syndrome (therapy)
• Aged
• Aged, 80 and over
• Clopidogrel (administration & dosage, adverse effects, therapeutic use)
• Female
• Hemorrhage (chemically induced)
• Humans
• Male
• Myocardial Infarction (epidemiology)
• Percutaneous Coronary Intervention (statistics & numerical data)
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects, therapeutic use)
• Propensity Score
• Registries
• Retrospective Studies
• Ticagrelor (administration & dosage, adverse effects, therapeutic use)