Highlights
- •Ticagrelor is not superior to clopidogrel in the Chinese population.
- •Ticagrelor decreased the risk of short-term thrombotic events in Chinese patients.
- •Ticagrelor increased the risk of BARC type 2 bleeding compared to clopidogrel.
Abstract
Background and aims
International guidelines recommend ticagrelor over clopidogrel as preferred antiplatelet
agent in patients following coronary stenting. However, no large real-life evidence
is available in East Asians in general, and Chinese in particular, with regard to
associated clinical outcomes. The present study aimed to assess the early and delayed
outcomes after ticagrelor versus clopidogrel in post stenting Chinese patients.
Methods
We conducted the pre-specified interim analysis of Comparison Of Efficacy and Safety Between TIcagrelor and Clopidogrel In Chinese (COSTIC), the ongoing prospective, observational, single-center
trial. Primary outcomes include first occurrence of myocardial infarction, stroke,
vascular death and Bleeding Academic Research Consortium (BARC) scale bleeding event.
Propensity score matching (PSM) was carried out to adjust for differences in baseline
characteristics between treatment arms.
Results
In total, 4,465 patients were enrolled. After PSM, the patients prescribed with ticagrelor
had a lower incidence of primary efficacy endpoint relative to those with clopidogrel
(0.6% vs. 1.4%, HR = 0.44, 95%CI: 0.22–0.89, p = 0.019) at 1 month, but similar at 7 days, 6 months and 12 months. Further analysis
indicated that the difference only exists in the subgroup of acute myocardial infarction
(AMI) patients. With regard to safety, ticagrelor consistently increased the risk
of BARC type 2 bleeding compared to clopidogrel at 1 month, 6 months and 12 months.
Conclusions
These preliminary data indicate that ticagrelor is superior to clopidogrel with regard
to major vascular thrombotic outcomes at 1 month, especially in the AMI population,
but both groups are similar at 7 days, 6 months and 12 months. Ticagrelor consistently
caused significantly more BARC type 2 bleeding.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: September 21, 2019
Accepted:
September 20,
2019
Received in revised form:
September 16,
2019
Received:
May 3,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
