YINGLONG: A Multicenter, Prospective, Non-Interventional Study Evaluating the Safety and Tolerability of Ticagrelor in Chinese Patients with Acute Coronary Syndrome

Xin Du, Yang Zheng, Ping Yang, Shuren Ma, Zaixin Yu, Xi Su, Junbo Ge, Maria Leonsson-Zachrisson, Xianhong Wang, Jing Sun, Lu Bai, Chang-Sheng Ma, YINGLONG study investigators, Xin Du, Yang Zheng, Ping Yang, Shuren Ma, Zaixin Yu, Xi Su, Junbo Ge, Maria Leonsson-Zachrisson, Xianhong Wang, Jing Sun, Lu Bai, Chang-Sheng Ma, YINGLONG study investigators

Abstract

Introduction: Ticagrelor is an oral, reversible, direct-acting P2Y12 receptor inhibitor approved for the prevention of cardiovascular events in acute coronary syndrome (ACS). In China, drug intensive monitoring regulations for new drugs require additional safety data post-approval.

Methods: YINGLONG, a single-arm, phase-IV, 1-year, non-interventional study, described the safety of ticagrelor 90 mg twice daily in Chinese patients (≥ 18 years) with ACS treated with ≥ 1 dose of ticagrelor. Primary outcomes were the incidence of adverse events (AEs), in particular, PLATelet inhibition and patient Outcomes (PLATO)-defined bleeding AEs, and other serious AEs during the 1-year follow-up. Key secondary outcomes were the incidence of major cardiovascular events.

Results: Patients (n = 1041, median age 61.0 years) had started ticagrelor and had post-dose data. Median duration of ticagrelor treatment was 357 days; 577 patients (55.4%) completed 1-year ticagrelor treatment; 973 patients (93.5%) completed 1-year follow-up. Overall, 38.7% of patients reported an AE during treatment. The most common AEs were dyspnea (n = 37, 3.6%), petechiae (n = 30, 2.9%), and chest discomfort (n = 28, 2.7%). Serious AEs, excluding bleeding, were reported in 9.8% of patients during treatment. Incidence of PLATO-defined major bleeding events was 1.1% (n = 11). Of the 21 deaths that occurred during the study (8 post-treatment), 1 was a fatal bleed. Major cardiovascular events were reported in 37 patients (3.6%).

Conclusions: Ticagrelor was well tolerated with a low rate of PLATO-defined major bleeding events in Chinese ACS patients. Safety results were consistent with the known ticagrelor profile.

Trial registration: ClinicalTrials.gov identifier, NCT02430493.

Funding: AstraZeneca Investment (China) Co., Ltd.

Keywords: Acute coronary syndrome; Bleeding; Cardiology; Chinese patients; Safety; Ticagrelor.

Figures

Fig. 1
Fig. 1
Patient disposition. *Three patients who discontinued ticagrelor before providing informed consent are excluded. AE adverse event, CABG coronary artery bypass grafting
Fig. 2
Fig. 2
Kaplan–Meier plot of time to first major cardiovascular event during the study. CV cardiovascular

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