경피적 관상동맥 중재술을 시행한 급성 관상동맥 증후군 환자에서 Ticagrelor와 Clopidogrel의 유효성과 안전성 비교

Abstract

Background : European and American guidelines recommend ticagrelor and prasugrel over clopidogrel in dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). However, ticagrelor and prasugrel are associated with a higher bleeding risk than clopidogrel. Thrombotic and bleeding tendencies also differ between Asian and non-Asian populations. Therefore, domestic studies and guidelines are needed to optimize antiplatelet therapy in Asian patients. This study aimed to compare the efficacy and safety of ticagrelor and clopidogrel in patients with ACS undergoing PCI to determine optimal antiplatelet therapy. Methods : This retrospective study included patients with ACS undergoing PCI who were treated with either ticagrelor or clopidogrel in a tertiary hospital between January 2022 and June 2023. Major adverse cardiovascular events (MACEs) and major bleeding events were analyzed to assess efficacy and safety, respectively. Results : This study analyzed 460 patients, including 129 (28.0%) who received ticagrelor and 331 (72.0%) who received clopidogrel. Analysis showed that the clopidogrel group was significantly older, while the proportion of male patients was higher in the ticagrelor group (p < 0.001 for both). The proportion of myocardial infarction among ACS types was higher in the ticagrelor group (p=0.009), while hypertension and diabetes were more common in the clopidogrel group (p=0.020 and p=0.001, respectively). The length of hospital stay was significantly longer in the clopidogrel group (p=0.007). To minimize bias, propensity score matching (1:1) was performed, resulting in 44 matched pairs (88 patients). Outcome analysis after matching showed no significant differences in MACEs (25.0 vs. 15.9%, p=0.290) or major bleeding events between ticagrelor and clopidogrel groups (0.0 vs. 4.5%, p=0.247). Conclusion : There was no significant difference in efficacy or safety between ticagrelor and clopidogrel in patients with ACS undergoing PCI. Further multicenter, prospective studies are needed to provide stronger evidence for optimal antiplatelet therapy.