Ticagrelor Versus Clopidogrel in Patients with Late or Very Late Stent Thrombosis

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.

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Acknowledgements

We thank Yang Wang, MSc, from the Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, for his professional suggestions regarding statistical analyses.

Funding

This research was supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (No. 2016-I2M-1-009) and the National Natural Science Foundation of China (No. 81970308).

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Affiliations

Authors

Contributions

Hongbing Yan, Li Song, and Hanjun Zhao contributed to the study conception and design. Material preparation was performed by Yu Tan, Chen Liu, and Peng Zhou. Data collection was performed by Zhaoxue Sheng, Jiannan Li, and Runzhen Chen. Analysis was performed by Jinying Zhou. The first draft of the manuscript was written by Jinying Zhou and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hongbing Yan.

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Conflict of Interest

The authors declare that they have no competing interests.

Ethics Approval

This is an observational study. The Review Board of Fuwai Hospital has confirmed that no ethical approval is required.

Data Availability

The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request.

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Zhou, J., Tan, Y., Liu, C. et al. Ticagrelor Versus Clopidogrel in Patients with Late or Very Late Stent Thrombosis. Cardiovasc Drugs Ther (2020). https://doi.org/10.1007/s10557-020-07021-w

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Keywords

  • Stent thrombosis
  • Ticagrelor
  • Clopidogrel
  • Antiplatelet therapy