Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in Elderly Patients Undergoing Percutaneous Coronary Intervention: A Cohort Study

Shaoke Meng, Lei Guo, Zhishuai Ye, Junjie Wang, Huaiyu Ding, Shanshan Wu, Rongchong Huang, Shaoke Meng, Lei Guo, Zhishuai Ye, Junjie Wang, Huaiyu Ding, Shanshan Wu, Rongchong Huang

Abstract

Background: Age is a strong predictor of adverse outcomes due both to a higher risk of bleeding and ischemia. The purpose of this study was to evaluate the safety and efficacy of ticagrelor in elderly patients.

Methods: Patients ≥75 years of age admitted to our center from January, 2015 to December, 2019 who had undergone percutaneous coronary intervention (PCI) and received dual antiplatelet therapy (DAPT) were included in our study. Eligible patients were divided into clopidogrel and ticagrelor groups according to the P2Y12 receptor inhibitor and were followed up for 1 year. The primary safety endpoint was types 2, 3, and 5 bleeding, as defined by Bleeding Academic Research Consortium (BARC), and the primary efficacy endpoint was combined major adverse cardiovascular and cerebrovascular events (MACCEs). A Cox proportional hazard model and propensity score matching were used to correct confounding factors.

Results: Of 1505 patients enrolled in this study, 442 were assigned to ticagrelor group and 1063 were assigned to clopidogrel group. The incidence of BARC 2, 3, and 5 bleeding (HR, 2.304; 95% CI, 1.540-3.447), and any bleeding (HR, 2.476; 95% CI, 1.802-3.403) in ticagrelor group was significantly higher than clopidogrel group. There were no significant difference between the two groups with respect to BARC 3 and 5 bleeding (HR, 1.566; 95% CI, 0.767-3.198) and MACCEs (HR, 0.957; 95% CI, 0.702-1.305).

Conclusion: Compared with clopidogrel, DAPT with ticagrelor significantly increased the risk of BARC 2, 3, and 5 bleeding without reducing MACCEs in elderly patients who underwent PCI.

Trial registration: The study was retrospectively registered in clinicaltrials.gov (NCT04999293).

Keywords: dual antiplatelet therapy; elderly; percutaneous coronary intervention; ticagrelor.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2022 Meng et al.

Figures

Figure 1
Figure 1
Flow chart of study.
Figure 2
Figure 2
Cumulative incidence of BARC 2, 3, and 5 bleeding (A), MACCEs (B), BARC 3 and 5 bleeding (C) during 12 months follow-up for ticagrelor vs clopidogrel based dual antiplatelet therapy in propensity-matched patients depicted by Kaplan–Meier survival curves.
Figure 3
Figure 3
Cumulative incidence of death (A), myocardial infarction (B), ischemic stroke (C), and any revascularization (D) during 12 months follow-up for ticagrelor vs clopidogrel based dual antiplatelet therapy in propensity-matched patients depicted by Kaplan–Meier survival curves.

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