Efficacy and Safety of Different Antiplatelet Strategies in Survivors of Myocardial Infarction With Acute Coronary Syndrome |
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| Affiliation: | 1. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China;2. Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, China;3. Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Chengdu, China;1. Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom;2. Department of Cardiology, St Thomas Hospital, London, United Kingdom;1. Department of Neurology, Santa Maria University Hospital, Terni, Italy;2. Chulalongkorn Center of Excellence on Parkinson''s Disease and Related Disorders, Chulalongkorn University Hospital, Bangkok, Thailand;3. Department of Neurorehabilitation, Gailtal-Klinik, Hermagor, Austria;4. Institute of Neurology, University College London, London, United Kingdom;5. Institute of Physical Medicine and Rehabilitation, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil;6. Global Medical Affairs, Ipsen Pharma, Boulogne-Billancourt, France;7. Serviço de Reabilitação de adultos 3, Centro de Medicina de Reabilitação de Alcoitão, Estoril, Portugal;1. Department of Adult Critical Care Medicine, Tainan Sin-Lau Hospital, Tainan, Taiwan;2. Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan;3. Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan;4. Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan;5. Department of Medicine, Chi-Mei Medical Center, Tainan, Taiwan;6. Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan;7. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan |
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| Abstract: | PurposeMany patients with acute coronary syndrome may experience recurrent myocardial infarction although they are receiving optional therapy, but they are still associated with poor clincial outcomes. The goal of this study was to assess different antiplatelet strategies in these patients.MethodsThis retrospective trial compared ticagrelor (180-mg loading dose, 90-mg BID maintenance dose) and clopidogrel (300- to 600-mg loading dose, 150-mg daily maintenance dose) for the prevention of cardiovascular events in 1083 patients with acute coronary syndrome and recurrent myocardial infarction admitted to the hospital undergoing percutaneous coronary intervention.FindingsAt the 24-month follow-up, a major adverse cardiovascular and cerebrovascular event (MACCE) occurred in 10.5% of patients receiving ticagrelor compared with 13.2% in the clopidogrel group (P = 0.023). Meanwhile, ticagrelor caused a higher rate of minor bleeding (18.1% vs 15.3%; P = 0.008). A survival analysis showed that ticagrelor decreased the incidence of MACCE (log-rank test, P < 0.001) and all-cause death (log-rank test, P = 0.001). The advantage of ticagrelor was also presented according to analysis of Seattle Angina Questionnaire scores.ImplicationsIn patients with recurrent myocardial infarction, the ticagrelor antiplatelet strategy significantly reduced the MACCE rate without increasing the risk of major bleeding, although patients did have a higher risk of minor bleeding. |
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| Keywords: | acute coronary syndrome clopidogrel MACCE recurrent ticagrelor |
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