Ticagrelor Versus Clopidogrel in Patients with Late or Very Late Stent Thrombosis
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ORIGINAL ARTICLE
Ticagrelor Versus Clopidogrel in Patients with Late or Very Late Stent Thrombosis Jinying Zhou 1 & Yu Tan 1,2 & Chen Liu 1 & Peng Zhou 1 & Zhaoxue Sheng 1 & Jiannan Li 1 & Runzhen Chen 1 & Hanjun Zhao 1 & Li Song 1 & Hongbing Yan 1,3 Accepted: 2 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To compare the effect of ticagrelor with clopidogrel in reducing the risk of ischemic cardiovascular events in patients with late or very late stent thrombosis (LST/VLST) after primary percutaneous coronary intervention (PCI). Methods A total of 4538 patients with acute coronary syndrome were screened for angiographically determined LST/VLST. Two hundred and forty-one patients were included in the analysis and grouped according to ticagrelor (n = 81) or clopidogrel (n = 160) at discharge. The clinical outcome was major adverse cardiovascular events (MACE) defined as death, myocardial infarction (MI), ischemic stroke, and revascularization during the 1-yr follow-up period. Results After propensity score matching, 65 pairs were generated. The incidence of MACE was significantly lower in the ticagrelor group compared with the clopidogrel group (9.3% vs. 21.5%, log-rank p = 0.048). However, no difference was observed in event rates of death, MI, ischemic stroke, and revascularization between the ticagrelor group and the clopidogrel group. Conclusion Following successful primary PCI, patients with LST/VLST who received ticagrelor had fewer ischemic cardiovascular events at 1-yr follow-up, compared with those who received clopidogrel. Keywords Stent thrombosis . Ticagrelor . Clopidogrel . Antiplatelet therapy
Introduction Stent thrombosis (ST) remains a rare but serious complication of percutaneous coronary intervention (PCI) [1, 2]. Primary PCI is less effective in patients with ST than those with de novo myocardial infarction [3]. Current guidelines recommend ticagrelor or prasugrel over clopidogrel for patients with acute coronary syndrome (ACS) [4, 5], but there is limited evidence regarding intensive anti-platelet therapy in patients with ST. This study aimed to verify the efficiency of ticagrelor
* Hongbing Yan [email protected] 1
Department of Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
2
Xiamen Cardiovascular Hospital, Xiamen University, Fujian, China
3
Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
versus clopidogrel, in addition to aspirin, in reducing adverse ischemic events in patients with late or very late ST (LST/ VLST) after primary PCI.
Methods Study Design and Population This was a retrospective cohort study, adhering to the Strengthening the Reporting of Observational Studies in Epidemiology statement [6]. Anonymized data, including demographic and clinical records, angiographic records, and prescriptions at discharge, were collected after discharge. From 1 January 2010 to 31 Decemb
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