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Effect of Ticagrelor versus Clopidogrel on All-Cause and Cardiovascular Mortality in Acute Coronary Syndrome Patients with Hyperuricemia

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Abstract

Background and Objective

The relationship between hyperuricemia and mortality in patients with acute coronary syndrome (ACS) is considerably controversial. Additionally, the strategy of dual antiplatelet therapy (DAPT) has not been evaluated in patients with ACS with hyperuricemia. This study aims to evaluate the impact of hyperuricemia on the prognosis of ACS and explore the efficacy of ticagrelor compared with clopidogrel in patients with hyperuricemia.

Methods

The study enrolled 4319 patients divided into hyperuricemia (HUA, n = 1060) and normouricemia (NUA, n = 3259) groups. The inverse probability of treatment weighting (IPTW)-adjusted Cox regression analysis was used to evaluate the impact of ticagrelor versus clopidogrel on all-cause and cardiovascular mortality.

Results

Hyperuricemia significantly increased the risk of all-cause death compared with patients with NUA at 7 days [adjusted hazard ratio (HR): 4.292, 95% confidence interval (CI) 1.727–10.67]; P = 0.002), 14 days (adjusted HR: 2.871, 95% CI 1.326–6.219; P = 0.0074), 30 days (adjusted HR: 2.168, 95% CI 1.056–4.453; P = 0.035), 3 months (adjusted HR: 2.018, 95% CI 1.152–3.533; P = 0.0144) and 1 year (adjusted HR: 1.702, 95% CI 1.137–2.548; P = 0.009). No significant difference was found between ticagrelor and clopidogrel in 1-year all-cause mortality [7.0% versus 5.5%, adjusted HR: 1.114 (95% CI 0.609–2.037), P = 0.725] among patients with concomitant hyperuricemia.

Conclusion

Hyperuricemia was independently related to an increased risk of all-cause and cardiovascular death in patients with ACS undergoing PCI. At 1-year follow-up, there were no significant differences between ticagrelor and clopidogrel concerning all-cause and cardiovascular death in patients with hyperuricemia.

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Acknowledgements

We gratefully thank all the participants in the study.

Author information

Author notes

  1. Shanshan Nie, Yuhang Zhao have contributed equally to this work.

Authors and Affiliations

  1. Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China

    Shanshan Nie, Chan Zou, Fangfang Ding & Guoping Yang

  2. Department of Cardiovascular Disease, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, Henan, China

    Shanshan Nie

  3. Department of Integrative Medicine, Hushan Hospital, Fudan Hospital, Shanghai, 200040, China

    Yuhang Zhao

  4. Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, 410013, Hunan, China

    Zeying Feng

  5. Department of Intensive Care Unit, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China

    Liying Gong

  6. Center for Experimental Medicine, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China

    Hongwei Lu

  7. Department of Cardiology, Central South University, The Third Xiangya Hospital, Changsha, 410013, Hunan, China

    Yu Cao

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  1. Shanshan Nie
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Correspondence to Yu Cao or Guoping Yang.

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Funding

No financial support was obtained from any individual, institutions, agencies, drug industries, or organizations.

Completing Interests

The authors have no relevant financial or nonfinancial interests to disclose.

Availability of Data and Material

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

Author Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Shanshan Nie, Yuhang Zhao, Zeying Feng, Yu Cao, and Guoping Yang. Data analysis was performed by Fangfang Ding, Zeying Feng, and Liying Gong. All authors commented on previous versions of the manuscript. The first draft of the manuscript was written by Shanshan Nie, and all authors read and edited the manuscript. All authors read and approved the final manuscript.

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This is an observational study. The Medical Ethics Committee of the Third Xiangya Hospital has confirmed that no ethical approval and informed consent are required (code number: R18030).

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Nie, S., Zhao, Y., Feng, Z. et al. Effect of Ticagrelor versus Clopidogrel on All-Cause and Cardiovascular Mortality in Acute Coronary Syndrome Patients with Hyperuricemia. Clin Drug Investig 44, 163–174 (2024). https://doi.org/10.1007/s40261-024-01342-6

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