경피적 관상동맥 중재술 시행 후 이중항혈소판요법 중인 비ST분절 상승 심근경색증 환자에서 Clopidogrel과 Ticagrelor의 효과 및 안전성 비교
Comparison of Ticagrelor and Clopidogrel in Patients with Non-ST Segment Elevated Myocardial Infarction (NSTEMI) under Double Antiplatelet Therapy after Percutaneous Coronary Intervention
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Background : The 2020 European Society of Cardiology (ESC) guidelines recommended ticagrelor and prasugrel over clopidogrel in dual antiplatelet therapy (DAPT) following percutaneous coronary inter vention (PCI) for patients with non-ST-segment elevation myocardial infarction (NSTEMI). This guidance poses challenges in Asian populations known to have lower thrombosis incidence but higher bleeding ten dency. Therefore, this study retrospectively evaluated the efficacy and safety of clopidogrel and ticagrelor in patients with NSTEMI undergoing DAPT post-PCI at a tertiary hospital. Methods : Electronic medical records of patients with NSTEMI undergoing PCI at our institution who were prescribed clopidogrel or ticagrelor for DAPT from January 2020 to December 2021 were retrospectively analyzed. Effectiveness was assessed by major adverse cardiac and cerebrovascular events (MACCE), comprising death, stroke, myocardial infarction, and revascularization. Safety was evaluated based on major and minor bleeding. Net Adverse Clinical Events (NACE) defined as the combination of MACCE and bleeding were analyzed to provide comprehensive assessment of efficacy and safety. Results : Among 184 eligible patients, 85 and 99 received clopidogrel and ticagrelor, respectively. The clopidogrel group had significantly higher bleeding risk (PRECISE-DAPT score median: 25.0, IQR: 16.5 32.5) than the ticagrelor group (PRECISE-DAPT score median: 13.0, IQR: 6.0-21.0) (p < 0.01). However, during the 12-month follow-up, no significant difference was observed in the occurrence of NACE be tween the clopidogrel group (10.6%) and the ticagrelor group (9.1%) (p=0.73). Incidences of MACCE and bleeding events were 7.1% and 3.5% in the clopidogrel group and 2.0% and 7.1% in the ticagrelor group, respectively, showing no significant intergroup differences (p=0.15 and p=0.35, respectively). Conclusion : NSTEMI patients undergoing DAPT post-PCI showed no significant differences in NACE, MACCE, or bleeding events between receiving clopidogrel and ticagrelor. However, given limitations of this single-center retrospective cohort study, additional prospective research is warranted to confirm these findings and to ensure more effective drug use in Asian patients.
Abstract
Background : The 2020 European Society of Cardiology (ESC) guidelines recommended ticagrelor and prasugrel over clopidogrel in dual antiplatelet therapy (DAPT) following percutaneous coronary inter vention (PCI) for patients with non-ST-segment elevation myocardial infarction (NSTEMI). This guidance poses challenges in Asian populations known to have lower thrombosis incidence but higher bleeding ten dency. Therefore, this study retrospectively evaluated the efficacy and safety of clopidogrel and ticagrelor in patients with NSTEMI undergoing DAPT post-PCI at a tertiary hospital. Methods : Electronic medical records of patients with NSTEMI undergoing PCI at our institution who were prescribed clopidogrel or ticagrelor for DAPT from January 2020 to December 2021 were retrospectively analyzed. Effectiveness was assessed by major adverse cardiac and cerebrovascular events (MACCE), comprising death, stroke, myocardial infarction, and revascularization. Safety was evaluated based on major and minor bleeding. Net Adverse Clinical Events (NACE) defined as the combination of MACCE and bleeding were analyzed to provide comprehensive assessment of efficacy and safety. Results : Among 184 eligible patients, 85 and 99 received clopidogrel and ticagrelor, respectively. The clopidogrel group had significantly higher bleeding risk (PRECISE-DAPT score median: 25.0, IQR: 16.5 32.5) than the ticagrelor group (PRECISE-DAPT score median: 13.0, IQR: 6.0-21.0) (p < 0.01). However, during the 12-month follow-up, no significant difference was observed in the occurrence of NACE be tween the clopidogrel group (10.6%) and the ticagrelor group (9.1%) (p=0.73). Incidences of MACCE and bleeding events were 7.1% and 3.5% in the clopidogrel group and 2.0% and 7.1% in the ticagrelor group, respectively, showing no significant intergroup differences (p=0.15 and p=0.35, respectively). Conclusion : NSTEMI patients undergoing DAPT post-PCI showed no significant differences in NACE, MACCE, or bleeding events between receiving clopidogrel and ticagrelor. However, given limitations of this single-center retrospective cohort study, additional prospective research is warranted to confirm these findings and to ensure more effective drug use in Asian patients.