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Efficacy and Safety of Ticagrelor Compared with Clopidogrel in Patients with End-Stage Renal Disease with Acute Myocardial Infarction

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Abstract

Objective

This study investigated the efficacy and safety of ticagrelor compared with clopidogrel in patients with end-stage renal disease (ESRD) and acute myocardial infarction (AMI).

Methods

We retrospectively enrolled patients who had received regular dialysis and had undergone percutaneous coronary intervention (PCI) for AMI at our hospital between January 2013 and December 2016. Outcomes analyzed included cardiovascular death, death from any cause, MI, stroke, and bleeding events.

Result

Patients were allocated to the ticagrelor group (N = 74) or the clopidogrel group (N = 116) according to the treatment they had received. No statistically significant differences were found between the groups in terms of in-hospital primary endpoint (composite of cardiovascular death, MI, and stroke: 12.2% and 15.5% for ticagrelor and clopidogrel, respectively; p = 0.518), secondary endpoint, or any bleeding events (39.2 vs. 34.5%; p = 0.511). No statistically significant differences were found for the 1-year primary endpoint (p = 0.424), secondary endpoint, and any bleeding events (p = 0.663). Risk factors for in-hospital cardiovascular death were shock and cardiopulmonary resuscitation at initial AMI presentation, lack of beta-blocker use, and in-hospital gastrointestinal bleeding. Risk factors for 1-year cardiovascular death were shock at initial AMI presentation and lack of beta-blocker use. Only respiratory failure was a risk factor for in-hospital and 1-year gastrointestinal bleeding.

Conclusion

In patients with ESRD and AMI, ticagrelor resulted in numerically fewer but statistically nonsignificant rates of in-hospital and 1-year cardiovascular events with no significant increase in bleeding events compared with clopidogrel.

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Acknowledgements

The authors thank the Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital, for their statistical work.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, 123, Ta Pei Road, Niao-Sung District, Kaohsiung, 83301, Taiwan

    Chien-Ho Lee, Tzu-Hsien Tsai, Cheng-Jui Lin, Shu-kai Hsueh, Wen-Jung Chung & Cheng-I Cheng

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  1. Chien-Ho Lee
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Correspondence to Cheng-I Cheng.

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No external funding was used in the preparation of this manuscript.

Conflicts of interest

C-HL, T-HT, C-JL, S-KH, W-JC, and C-IC have no conflicts of interest that are directly relevant to the content of this article.

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Lee, CH., Tsai, TH., Lin, CJ. et al. Efficacy and Safety of Ticagrelor Compared with Clopidogrel in Patients with End-Stage Renal Disease with Acute Myocardial Infarction. Am J Cardiovasc Drugs 19, 325–334 (2019). https://doi.org/10.1007/s40256-018-00318-0

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  • DOI: https://doi.org/10.1007/s40256-018-00318-0

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