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Comparative Effectiveness and Safety of Ticagrelor Versus Clopidogrel for Elderly Chinese Patients Undergoing Percutaneous Coronary Intervention: A Single-Center Retrospective Cohort Study

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Abstract

Background

Taking ischemic and bleeding risks into consideration, insufficient data exist on dual antiplatelet therapy after percutaneous coronary intervention in elderly Chinese patients with coronary artery disease.

Objective

We aimed to investigate the effectiveness and safety of ticagrelor in comparison with clopidogrel on a background of aspirin for elderly Chinese patients with coronary artery disease 12 months after percutaneous coronary intervention.

Methods

A single-center retrospective cohort study was conducted. Selected from patients with coronary artery disease aged ≥ 75 years from January 2010 to July 2019, 908 eligible subjects receiving dual antiplatelet therapy after percutaneous coronary intervention for up to 12 months were consecutively enrolled in the study. The included patients received ticagrelor in combination with aspirin (n = 264) or clopidogrel in combination with aspirin (n = 644). Effectiveness endpoints were evaluated by the major adverse cardiovascular events, encompassing all-cause death, non-fatal myocardial infarction, and clinically driven revascularization. The safety endpoints were recorded as the incidence of Bleeding Academic Research Consortium bleeding.

Results

The patients who were treated with ticagrelor were slightly younger than those who were treated with clopidogrel (79.1 ± 3.7 vs 80.7 ± 4.5 years, p < 0.01). The ticagrelor cohort contained a higher percentage of patients undergoing a prior percutaneous coronary intervention (37.9% vs 24.5%, p < 0.01), and a lower percentage of smokers (19.3% vs 27.2%, p < 0.05), compared with the clopidogrel cohort. The levels of glucose, total cholesterol, and low-density lipoprotein-cholesterol in the ticagrelor group were higher while the level of triglycerides and high-density lipoprotein-cholesterol were lower (p < 0.05) than those in the clopidogrel group. Left main percutaneous coronary intervention was performed more frequently among the ticagrelor-treated patients (23.5% vs 9.3%, p < 0.01), while patients in the clopidogrel group underwent more left circumflex percutaneous coronary intervention (34.3% vs 23.1%, p < 0.01). We found that ticagrelor was associated with a lower incidence of major adverse cardiovascular events than clopidogrel using the inverse probability of treatment weighting model (odds ratio, 0.493; 95% confidence interval 0.356–0.684). There was no difference in terms of the risk of Bleeding Academic Research Consortium bleeding between the two groups (p > 0.05).

Conclusions

Ticagrelor was associated with a lower incidence of major adverse cardiovascular events than clopidogrel at 12 months in elderly Chinese patients with coronary artery disease, without a significant increase of Bleeding Academic Research Consortium bleeding events.

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References

  1. Saito Y, Kobayashi Y. Update on antithrombotic therapy after percutaneous coronary intervention. Intern Med. 2020;59(3):311–21.

    Article  CAS  Google Scholar 

  2. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the Task Force for Dual Antiplatelet Therapy in Coronary Artery Disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213–60.

    Article  Google Scholar 

  3. Liang ZY, Han YL, Zhang XL, Li Y, Yan CH, Kang J. The impact of gene polymorphism and high on-treatment platelet reactivity on clinical follow-up: outcomes in patients with acute coronary syndrome after drug-eluting stent implantation. EuroIntervention. 2013;9(3):316–27.

    Article  Google Scholar 

  4. Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE Jr, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2012;126(7):875–910.

    Article  Google Scholar 

  5. Oprea AD, Popescu WM. P2Y12 receptor inhibitors in acute coronary syndromes: what is new on the horizon. Cardiol Res Pract. 2013;2013: 195456.

    Article  Google Scholar 

  6. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Thorac Cardiovasc Surg. 2016;152(5):1243–75.

    Article  Google Scholar 

  7. Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW. Coronary artery disease in patients ≥80 years of age. J Am Coll Cardiol. 2018;71(18):2015–40.

    Article  Google Scholar 

  8. Savonitto S, Morici N, De Servi S. Antiplatelet therapy for elderly patients with acute coronary syndromes. Aging (Albany NY). 2018;10(9):2220–1.

    Article  Google Scholar 

  9. Barillà F, Torromeo C, Iorio R, Porco L, Paravati V, Gaudio C. Antiplatelet therapy in elderly patients with acute coronary syndrome: between scientific evidence and future perspectives. Monaldi Arch Chest Dis. 2018;88(2):952.

    Article  Google Scholar 

  10. De Rosa R, Piscione F, Galasso G, De Servi S, Savonitto S. Antiplatelet therapy in very elderly and comorbid patients with acute coronary syndromes. J Geriatr Cardiol. 2019;16(2):103–13.

    PubMed  PubMed Central  Google Scholar 

  11. Capodanno D, Greco A. Risk stratification for bleeding in the elderly with acute coronary syndrome: not so simple. Thromb Haemost. 2018;118(6):949–52.

    Article  Google Scholar 

  12. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045–57.

    Article  CAS  Google Scholar 

  13. Kang HJ, Clare RM, Gao R, Held C, Himmelmann A, James SK, et al. Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: a retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial. Am Heart J. 2015;169(6):899-905.e1.

    Article  CAS  Google Scholar 

  14. Gao R, Wu Y, Liu H, Su G, Yuan Z, Zhang A, et al. Safety and incidence of cardiovascular events in Chinese patients with acute coronary syndrome treated with ticagrelor: the 12-month, phase IV, multicenter, single-arm DAYU study. Cardiovasc Drugs Ther. 2018;32(1):47–56.

    Article  CAS  Google Scholar 

  15. Du X, Zheng Y, Yang P, Ma S, Yu Z, Su X, et al. YINGLONG: a multicenter, prospective, non-interventional study evaluating the safety and tolerability of ticagrelor in Chinese patients with acute coronary syndrome. Adv Ther. 2019;36(7):1595–605.

    Article  CAS  Google Scholar 

  16. Centers for Disease Control and Prevention (CDC). Trends in aging: United States and worldwide. MMWR Morb Mortal Wkly Rep. 2003;52(6):101–4, 106.

  17. Cui K, Lyu S, Song X, Liu H, Yuan F, Xu F, et al. Long-term safety and efficacy of staged percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction and multivessel coronary disease. Am J Cardiol. 2019;124(3):334–42.

    Article  Google Scholar 

  18. Van den Berg EK, Schmitz JM, Benedict CR, Willerson JT, Dehmer GJ. Transcardiac serotonin concentration is increased in selected patients with limiting angina and complex coronary lesion morphology. Circulation. 1989;79(1):116–24.

    Article  Google Scholar 

  19. Hicks KA, Mahaffey KW, Mehran R, Nissen SE, Wiviott SD, Dunn B, et al. 2017 Cardiovascular and stroke endpoint definitions for clinical trials. J Am Coll Cardiol. 2018;71(9):1021–34.

    Article  Google Scholar 

  20. Toma A, Stähli BE, Gick M, Gick M, Colmsee H, Gebhard C, et al. Long-term follow-up of patients with previous coronary artery bypass grafting undergoing percutaneous coronary intervention for chronic total occlusion. Am J Cardiol. 2016;118(11):1641–6.

    Article  Google Scholar 

  21. Scheinert D, Micari A, Brodmann M, Tepe G, Peeters P, et al. Drug-coated balloon treatment for femoropopliteal artery disease. Circ Cardiovasc Interv. 2018;11(10): e005654.

    Article  Google Scholar 

  22. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123(23):2736–47.

    Article  Google Scholar 

  23. Brilinta™ (ticagrelor) tablets: A P2Y(12) platelet inhibitor indicated to reduce the rate of thrombotic cardiovascular events in patients with acute coronary syndrome (ACS). P T. 2012;37(4 section 2):4–18.

  24. Husted S, James S, Becker RC, Horrow J, Katus H, Storey RF, Cannon CP, et al. Ticagrelor versus clopidogrel in elderly patients with acute coronary syndromes: a substudy from the prospective randomized PLATelet inhibition and patient Outcomes (PLATO) trial. Circ Cardiovasc Qual Outcomes. 2012;5(5):680–8.

    Article  Google Scholar 

  25. Chen IC, Lee CH, Fang CC, Chao TH, Cheng CL, Chen Y, et al. Efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome in Taiwan: a multicenter retrospective pilot study. J Chin Med Assoc. 2016;79(10):521–30.

    Article  Google Scholar 

  26. Vranckx P, Valgimigli M, Jüni P, Hamm C, Steg PG, Heg D, et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet. 2018;392(10151):940–9.

    Article  CAS  Google Scholar 

  27. Mehran R, Baber U, Sharma SK, Cohen DJ, Angiolillo DJ, Briguori C, et al. Ticagrelor with or without aspirin in high-risk patients after PCI. N Engl J Med. 2019;381(21):2032–42.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank the patients and personnel who supported this study.

Author information

Author notes

  1. Suining Xu, Ying Liang, and Yan Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi’an, Shannxi, People’s Republic of China

    Suining Xu, Haokao Gao, Qiong Wang, Shuai Zhao, Li Yang, Yamin Zhang, Chengxiang Li & Kun Lian

  2. Department of Cardiology, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shannxi, People’s Republic of China

    Suining Xu & Anji Zhang

  3. Department of Health Statistics, Fourth Military Medical University, Xi’an, Shannxi, People’s Republic of China

    Ying Liang & Zhijun Tan

  4. Department of Cardiology, No. 971 Hospital of the PLA Navy, QingDao, Shandong, People’s Republic of China

    Yan Chen

  5. School of Basic Medicine, Fourth Military Medical University, Xi’an, Shannxi, People’s Republic of China

    Qingyi Wang

  6. Department of Cardiac Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shannxi, People’s Republic of China

    Yang Liu

  7. Cadet Brigade, School of Basic Medicine, Fourth Military Medical University, Xi’an, Shannxi, People’s Republic of China

    Boda Zhu, Ziwei Wang & Yuhao Chen

  8. Department of Naval Medicine, Naval Medical University, Shanghai, People’s Republic of China

    Feng Tao

  9. 981 Hospital of Joint Logistics Support Force, Chengde, Hebei, People’s Republic of China

    Peng Han

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  1. Suining Xu
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Corresponding authors

Correspondence to Chengxiang Li or Kun Lian.

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Funding

This work was supported by the Xi’an Science and Technology Project (20YXYJ0003(4)); Bethune-Merck Diabetes Research Foundation (G2017044); “Advanced Foundation” of Xinxin Cardiovascular Health Foundation in Suzhou Industrial Park (2019-CCAACCESS065); New Clinical Technology and New Business of Xijing Hospital (XJGX15Y39); National Natural Science Foundation of China (81670229 and 81570210); National Science Fund for Young Scholars of China (81702733); and the Open Program of Shaanxi Key Laboratory of Ischemic Cardiovascular Disease (2018ZDKF05).

Conflicts of interest/competing interests

All authors have no conflicts of interest that are directly relevant to the content of this article.

Ethics approval

This study protocol was approved by the Ethics Committee of the Fourth Military Medical University (KY20172019-1).

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All patients provided written informed consent.

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Not applicable.

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Authors’ Contributions

All authors contributed to the design of the analysis, data acquisition and interpretation, and to the drafting and revising of the manuscript.

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Xu, S., Liang, Y., Chen, Y. et al. Comparative Effectiveness and Safety of Ticagrelor Versus Clopidogrel for Elderly Chinese Patients Undergoing Percutaneous Coronary Intervention: A Single-Center Retrospective Cohort Study. Drugs Aging 39, 695–703 (2022). https://doi.org/10.1007/s40266-022-00971-w

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