Cargando…

P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Background: P2Y12 inhibitor monotherapy is an alternative antiplatelet strategy in patients undergoing percutaneous coronary intervention (PCI). However, the ideal P2Y12 inhibitor for monotherapy is unclear. Methods and Results: We performed a multicenter, retrospective, observational study to compa...

Descripción completa

Detalles Bibliográficos
Autores principales: Chen, Po-Wei, Feng, Wen-Han, Ho, Ming-Yun, Su, Chun-Hung, Huang, Sheng-Wei, Cheng, Chung-Wei, Yeh, Hung-I, Chen, Ching-Pei, Huang, Wei-Chun, Fang, Ching-Chang, Lin, Hui-Wen, Lin, Sheng-Hsiang, Hsieh, I-Chang, Li, Yi-Heng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355760/
https://www.ncbi.nlm.nih.gov/pubmed/32492818
http://dx.doi.org/10.3390/jcm9061657
_version_ 1783558350132215808
author Chen, Po-Wei
Feng, Wen-Han
Ho, Ming-Yun
Su, Chun-Hung
Huang, Sheng-Wei
Cheng, Chung-Wei
Yeh, Hung-I
Chen, Ching-Pei
Huang, Wei-Chun
Fang, Ching-Chang
Lin, Hui-Wen
Lin, Sheng-Hsiang
Hsieh, I-Chang
Li, Yi-Heng
author_facet Chen, Po-Wei
Feng, Wen-Han
Ho, Ming-Yun
Su, Chun-Hung
Huang, Sheng-Wei
Cheng, Chung-Wei
Yeh, Hung-I
Chen, Ching-Pei
Huang, Wei-Chun
Fang, Ching-Chang
Lin, Hui-Wen
Lin, Sheng-Hsiang
Hsieh, I-Chang
Li, Yi-Heng
author_sort Chen, Po-Wei
collection PubMed
description Background: P2Y12 inhibitor monotherapy is an alternative antiplatelet strategy in patients undergoing percutaneous coronary intervention (PCI). However, the ideal P2Y12 inhibitor for monotherapy is unclear. Methods and Results: We performed a multicenter, retrospective, observational study to compare the efficacy and safety of monotherapy with clopidogrel versus ticagrelor in patients with acute coronary syndrome (ACS) undergoing PCI. From 1 January 2014 to 31 December 2018, 610 patients with ACS who received P2Y12 monotherapy with either clopidogrel (n = 369) or ticagrelor (n = 241) after aspirin was discontinued prematurely were included. Inverse probability of treatment weighting was used to balance covariates between the groups. The primary endpoint was the composite of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months after discharge. Overall, 84 patients reached the primary endpoint, with 57 (15.5%) in the clopidogrel group and 27 (11.2%) in the ticagrelor group. Multivariate adjustment in Cox proportional-hazards models revealed a lower risk of the primary endpoint with ticagrelor than with clopidogrel (adjusted hazard ratio (aHR): 0.67, 95% confidence interval (CI): 0.49–0.93). Ticagrelor significantly reduced the risk of recurrent ACS or unplanned revascularization (aHR: 0.46, 95% CI: 0.28–0.75). No significant difference in all-cause mortality and major bleeding events was observed between the 2 groups. Conclusions: Among patients with ACS undergoing PCI who cannot complete course of dual antiplatelet therapy, a significantly lower risk of cardiovascular events was associated with ticagrelor monotherapy than with clopidogrel monotherapy. The major bleeding risk was similar in both the groups.
format Online
Article
Text
id pubmed-7355760
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-73557602020-07-23 P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Chen, Po-Wei Feng, Wen-Han Ho, Ming-Yun Su, Chun-Hung Huang, Sheng-Wei Cheng, Chung-Wei Yeh, Hung-I Chen, Ching-Pei Huang, Wei-Chun Fang, Ching-Chang Lin, Hui-Wen Lin, Sheng-Hsiang Hsieh, I-Chang Li, Yi-Heng J Clin Med Article Background: P2Y12 inhibitor monotherapy is an alternative antiplatelet strategy in patients undergoing percutaneous coronary intervention (PCI). However, the ideal P2Y12 inhibitor for monotherapy is unclear. Methods and Results: We performed a multicenter, retrospective, observational study to compare the efficacy and safety of monotherapy with clopidogrel versus ticagrelor in patients with acute coronary syndrome (ACS) undergoing PCI. From 1 January 2014 to 31 December 2018, 610 patients with ACS who received P2Y12 monotherapy with either clopidogrel (n = 369) or ticagrelor (n = 241) after aspirin was discontinued prematurely were included. Inverse probability of treatment weighting was used to balance covariates between the groups. The primary endpoint was the composite of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months after discharge. Overall, 84 patients reached the primary endpoint, with 57 (15.5%) in the clopidogrel group and 27 (11.2%) in the ticagrelor group. Multivariate adjustment in Cox proportional-hazards models revealed a lower risk of the primary endpoint with ticagrelor than with clopidogrel (adjusted hazard ratio (aHR): 0.67, 95% confidence interval (CI): 0.49–0.93). Ticagrelor significantly reduced the risk of recurrent ACS or unplanned revascularization (aHR: 0.46, 95% CI: 0.28–0.75). No significant difference in all-cause mortality and major bleeding events was observed between the 2 groups. Conclusions: Among patients with ACS undergoing PCI who cannot complete course of dual antiplatelet therapy, a significantly lower risk of cardiovascular events was associated with ticagrelor monotherapy than with clopidogrel monotherapy. The major bleeding risk was similar in both the groups. MDPI 2020-06-01 /pmc/articles/PMC7355760/ /pubmed/32492818 http://dx.doi.org/10.3390/jcm9061657 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Chen, Po-Wei
Feng, Wen-Han
Ho, Ming-Yun
Su, Chun-Hung
Huang, Sheng-Wei
Cheng, Chung-Wei
Yeh, Hung-I
Chen, Ching-Pei
Huang, Wei-Chun
Fang, Ching-Chang
Lin, Hui-Wen
Lin, Sheng-Hsiang
Hsieh, I-Chang
Li, Yi-Heng
P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
title P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
title_full P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
title_fullStr P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
title_full_unstemmed P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
title_short P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
title_sort p2y12 inhibitor monotherapy with clopidogrel versus ticagrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355760/
https://www.ncbi.nlm.nih.gov/pubmed/32492818
http://dx.doi.org/10.3390/jcm9061657
work_keys_str_mv AT chenpowei p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT fengwenhan p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT homingyun p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT suchunhung p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT huangshengwei p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT chengchungwei p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT yehhungi p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT chenchingpei p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT huangweichun p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT fangchingchang p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT linhuiwen p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT linshenghsiang p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT hsiehichang p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention
AT liyiheng p2y12inhibitormonotherapywithclopidogrelversusticagrelorinpatientswithacutecoronarysyndromeundergoingpercutaneouscoronaryintervention