경피적 관상동맥 중재 시술 후 이중 항혈소판 치료를 받는 환자에서 aspirin 병용 약제의 종류에 따른 심혈관계 사건 발생률 비교

Abstract

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor antagonist, which reduces ischemic adverse events, is the established standard of care in acute coronary syndrome (ACS) patients who have undergone percutaneous coronary intervention (PCI). Guidelines of the European Society of Cardiology, American College of Cardiology/American Heart Association, and the Korean society interventional cardiology, recommend the use of clopidogrel, prasugrel, or ticagrelor in combination with aspirin as DAPT. However, there are differences amongst the various guidelines, in detailed recommendations for P2Y12 receptor antagonists. This study aimed to compare the incidence of cardiovascular events according to the type of P2Y12 receptor antagonists in combination with aspirin, in post-PCI DAPT patients. This retrospective study was a follow up after 12 months of starting DAPT, in ACS patients who had undergone PCI at the Severance Hospital between January 1, 2014 to December 31, 2014. Patients were divided into 2 groups: clopidogrel group and ticagrelor group, according to the P2Y12 receptor antagonist combined with aspirin. The baseline characteristics of patients and incidence of cardiovascular events (mortality, myocardial infarction, stent thrombosis, stroke, and bleeding) were analyzed and compared between groups. A total of 715 patients were divided into the clopidogrel group (n=635) and the ticagrelor group (n=80). Total incidence of cardiovascular events was higher in the ticagrelor group than clopidogrel group(11.3% vs. 5.7%, respectively; p=0.081). There was no significant difference in the incidence of death, myocardial infarction, stent thrombosis and stroke, but the incidence of bleeding was significantly higher in the ticagrelor group than in the clopidogrel group(7.5% vs. 2.4%, respectively; p 0.05). This study revealed the differences in the incidence of cardiovascular events according to the type of P2Y12 receptor antagonists used in combination with aspirin as DAPT. As compared with clopidogrel, a higher rate of bleeding with ticagrelor suggests that ticagrelor should be used with caution due to an increased risk of bleeding.