Efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome in Taiwan: A multicenter retrospective pilot study

作者：I‐Chih Chen, Cheng‐Han Lee, Ching‐Chang Fang, Ting‐Hsing Chao, Ching‐Lan Cheng, Yi Chen, Ching‐Lung Yu, Chih‐Chan Lin, Chun-Yuan Lin, Yi‐Heng Li · 发表于：Journal of the Chinese Medical Association · 年份：2016 · DOI：10.1016/j.jcma.2016.02.010 · 被引用次数：45 · 研究领域：Antiplatelet Therapy and Cardiovascular Diseases、Atrial Fibrillation Management and Outcomes、Acute Myocardial Infarction Research

BACKGROUND: The efficacy and safety of ticagrelor compared with clopidogrel in acute coronary syndrome has not previously been evaluated in an Eastern Asian population, which is recognized to have a different response to P2Y12 antagonists compared with the Caucasian population in real-life situations. METHODS: A multicenter retrospective pilot study was performed to evaluate 928 consecutive patients with acute coronary syndrome, receiving aspirin and one P2Y12 antagonist (324 ticagrelor or 604 clopidogrel). Using propensity score matching, 448 patients were selected and divided into two equal groups. Kaplan-Meier analysis was used to study patient survival and event-free status using the log-rank test. Independent covariates were identified using univariate in a multivariate Cox proportional hazard model. RESULTS: In the overall cohort, significant differences were observed for certain variables between the two groups. During the mean 164.3 (±116.4)-day follow-up in the overall cohort, ticagrelor treatment had no significant effect on the primary efficacy endpoint (myocardial infarction, stroke, or vascular death); however, in the matched cohort, ticagrelor showed a lower incidence of primary endpoint (hazard ratio: 0.56; 95% confidence interval: 0.30-1.04; p = 0.07) and stroke (hazard ratio: 0.15; 95% confidence interval: 0.02-1.24; p = 0.08) with marginal statistical significance, and a similar bleeding rate. The protective effect of ticagrelor treatment was consistent for ...