Factors predicting the occurrence of net adverse clinical and cerebral events in patients with acute coronary syndrome treated with clopidogrel or ticagrelor in combination with aspirin: a real-world study

BACKGROUND: This study aimed to establish the factors influencing the clinical benefits of ticagrelor and clopidogrel for acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) surgery. METHODS: A multicenter, retrospective, real-world study was conducted on patients with ACS whose data were sourced from 3 databases, namely the BRIC-ACS(I) study, COSTIC study, and 301 Hospital PCI patient database from January 2014 to October 2017. The primary endpoint was net adverse clinical and cerebral events (NACCE). RESULTS: A total of 7,236 ACS patients were included, of which 4,444 patients (61.4%) and 2,792 patients (38.6%) were in the clopidogrel dual antiplatelet therapy (DAPT) group and ticagrelor DAPT group, respectively. The hazard ratio (HR) for NACCE was significantly higher in patients aged ≥65 years than those aged ≤65 years in the clopidogrel DAPT group (HR: 2.15, 95% CI: 1.68–2.76) and ticagrelor DAPT group (HR: 1.75, 95% CI: 1.34–2.29). In patients treated with clopidogrel DAPT, patients with unstable angina had a significantly lower HR for NACCE than patients with ST-elevation myocardial infarction. Use of beta blockers (HR: 0.77, 95% CI: 0.60–0.99) was an influencing factor in patients treated with clopidogrel DAPT, whereas in patients treated with ticagrelor DAPT, only smoking status (HR: 0.75, 95% CI: 0.57–0.99) was a significant influencing factor. CONCLUSIONS: Age, hypertension status, and presence or absence of unstable angina were factors influencing the composite outcome of NACCE. The selection of patients to be treated with either clopidogrel DAPT or ticagrelor DAPT depending on the presence or absence of factors influencing treatment outcome may improve therapeutic management.