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Ticagrelor versus clopidogrel in acute myocardial infarction patients with multivessel disease; From Korea Acute Myocardial Infarction Registry-National Institute of Health

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Author(s)
Myung Ho Jeong: Ju Han KimYoung Joon HongDoo Sun SimMin Chul KimJin Yong HwangJung Han YoonIn Whan SeongSeung-Ho HurSeokKyuOh
Keimyung Author(s)
Hur, Seung Ho
Department
Dept. of Internal Medicine (내과학)
Journal Title
Journal of Cardiology
Issued Date
2019
Volume
75
Issue
5
Keyword
Multivessel diseaseAcute myocardial infarctionEast Asian populationsTicagrelor
Abstract
Background:
The clinical efficacy of ticagrelor is questionable in East Asian populations. Patients with acute myocardial infarction (AMI) with multivessel disease (MVD) are considered as high risk patients who might benefit from ticagrelor treatment. The purpose of this study is to compare the clinical effect of ticagrelor and clopidogrel in AMI patients with MVD in Korea.

Methods and results:
A total of 2275 patients between November 2011 and June 2015, diagnosed with AMI with MVD after successful percutaneous coronary intervention who were registered in the Korea Acute Myocardial Infarction Registry – National Institute of Health (KAMIR-NIH) were enrolled. Patients were divided into ticagrelor (n = 837) and clopidogrel group (n = 1438). The primary endpoint was major adverse cardiac events (MACE) defined as cardiac death, non-fatal MI, target vessel revascularization, or ischemic stroke during 2 years of clinical follow-up. Secondary endpoints were thrombolysis in myocardial infarction (TIMI) major or minor bleeding, net clinical event composed of MACE and TIMI major bleeding, any repeated percutaneous coronary intervention, heart failure requiring re-hospitalization, and stent thrombosis. After propensity score matching analysis, the primary endpoint was lower in ticagrelor group compared to the clopidogrel group (8.6 % vs. 11.9 %; HR: 0.68; 95 % CI: 0.50-0.94; p = 0.018). The risk of TIMI major or minor bleeding was higher in the ticagrelor group (10.8 % vs. 4.8 %; HR: 2.51; 95 % CI: 1.68–3.76; p < 0.001). The net clinical event was similar between ticagrelor and clopidogrel group (11.3 % vs. 13.6 %; HR 0.82; 95 % CI: 0.60–1.11; p = 0.195).

Conclusion:
Ticagrelor significantly reduced the risk of MACE than clopidogrel for AMI patients with MVD in Korea. However, the risk of TIMI major or minor bleeding was higher and the net clinical benefit was similar. Further large-scale multi-center randomized clinical trials are needed to clarify the proper use dual antiplatelet therapy in East Asian populations.
Keimyung Author(s)(Kor)
허승호
Publisher
School of Medicine (의과대학)
Citation
Myung Ho Jeong: Ju Han Kim et al. (2019). Ticagrelor versus clopidogrel in acute myocardial infarction patients with multivessel disease; From Korea Acute Myocardial Infarction Registry-National Institute of Health. Journal of Cardiology, 75(5), 478–484. doi: 10.1016/j.jjcc.2019.11.003
Type
Article
ISSN
1876-4738
Source
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0914508719303430
DOI
10.1016/j.jjcc.2019.11.003
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/42638
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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