Ticagrelor vs Clopidogrel in Clopidogrel-Naive Patients With Chronic Coronary Syndrome
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články, srovnávací studie, multicentrická studie, randomizované kontrolované studie
PubMed
38842993
DOI
10.1016/j.jcin.2024.04.015
PII: S1936-8798(24)00652-6
Knihovny.cz E-zdroje
- Klíčová slova
- cardiovascular outcomes, chronic coronary syndrome, clopidogrel, dual antiplatelet therapy, elective percutaneous intervention, ticagrelor,
- MeSH
- časové faktory MeSH
- chronická nemoc MeSH
- hodnocení rizik MeSH
- infarkt myokardu * mortalita MeSH
- inhibitory agregace trombocytů * škodlivé účinky terapeutické užití MeSH
- klopidogrel * škodlivé účinky terapeutické užití aplikace a dávkování MeSH
- koronární angioplastika * škodlivé účinky mortalita MeSH
- krvácení chemicky indukované MeSH
- lidé středního věku MeSH
- lidé MeSH
- nekróza MeSH
- nemoci koronárních tepen terapie mortalita diagnostické zobrazování farmakoterapie MeSH
- purinergní receptory P2Y - antagonisté škodlivé účinky terapeutické užití MeSH
- rizikové faktory MeSH
- senioři MeSH
- stenty MeSH
- ticagrelor * škodlivé účinky terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- Názvy látek
- inhibitory agregace trombocytů * MeSH
- klopidogrel * MeSH
- purinergní receptory P2Y - antagonisté MeSH
- ticagrelor * MeSH
BACKGROUND: Whether ticagrelor may reduce periprocedural myocardial necrosis after elective percutaneous coronary intervention (PCI) in patients with and without chronic clopidogrel therapy is unclear. OBJECTIVES: This study sought to compare ticagrelor vs clopidogrel in patients with and without chronic clopidogrel therapy before undergoing elective PCI. METHODS: In this prespecified analysis of the ALPHEUS (Assessment of Loading With the P2Y12 Inhibitor Ticagrelor or Clopidogrel to Halt Ischemic Events in Patients Undergoing Elective Coronary Stenting) trial, patients were defined as clopidogrel(+) and clopidogrel(-) according to the presence and absence of clopidogrel treatment for ≥7 days before PCI, respectively. The primary endpoint was the composite of PCI-related myocardial infarction and major injury as defined by the third and fourth universal definition 48 hours after PCI. RESULTS: A total of 1,882 patients were included, 805 (42.7%) of whom were clopidogrel(+). These patients were older, had more comorbidities, and had more frequent features of complex PCI. The primary endpoint was less frequently present in clopidogrel(-) compared to clopidogrel(+) patients (32.8% vs 40.0%; OR: 0.73; 95% CI: 0.60-0.88), but no significant differences were reported for the risk of death, myocardial infarction, stroke, or transient ischemic attack at 48 hours or 30 days. Ticagrelor did not reduce periprocedural myocardial necrosis or the risk of adverse outcomes, and there was no significant interaction regarding the presence of chronic clopidogrel treatment. CONCLUSIONS: Clopidogrel-naive patients presented less periprocedural complications compared to clopidogrel(+) patients, a difference related to a lower risk profile and less complex PCI. The absence of clopidogrel at baseline did not affect the absence of a difference between ticagrelor and clopidogrel in terms of PCI-related complications supporting the use of clopidogrel as the standard of care in elective PCI in patients with or without chronic clopidogrel treatment.
ACTION Study Group Unité de Recherche Clinique Lariboisière Hospital AP HP Paris France
Cardiology Department Bordeaux University Hospital Pessac France
Cardiology Department Bretagne Atlantique Hospital Vannes France
Cardiology Department Caen University Hospital Normandie University ACTION Study Group Caen France
Cardiology Department Chartres Hospital Chartres France
Cardiology Department CHU Dijon Bourgogne Dijon France
Cardiology Department Grand Hôpital de l'Est Francilien Jossigny France
Cardiology Department Henri Mondor Hospital Créteil France
Cardiology Department Saint Nazaire Hospital Saint Nazaire France
Service de Cardiologie Clinique Saint Gatien Saint Cyr sur Loire France
Sorbonne Université Allies in Cardiovascular Trials Initiatives and Organized Networks Paris France
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