High-dose clopidogrel versus ticagrelor for treatment of acute coronary syndromes after percutaneous coronary intervention in CYP2C19 intermediate or poor metabolizers: a prospective, randomized, open-label, single-centre trial.

Objective The present study was designed to compare the outcome and safety of dual antiplatelet therapies (DAPTs) in patients with acute coronary syndrome (ACS) (intermediate metabolizers [IM] or poor metabolizers [PM]) undergoing percutaneous coronary intervention (PCI).Methods and results From September 20, 2013, to June 8, 2014, the study enrolled 329 patients with ACS scheduled for PCI. Of these, 181 (55%) patients with IM or PM were randomized in a 1:1 ratio to receive either high-dose clopidogrel or ticagrelor. The high-dose clopidogrel group received a 600-mg loading dose (LD) and finally 75 mg QD, and the ticagrelor group received 180 mg LD following 90 mg b.i.d. After 6 months of DAPT, the primary end point (composition of death, stroke, recurrent myocardial infarction [MI], and stent thrombosis) occurred in 4.4% of patients receiving ticagrelor compared with 20.0% of those receiving high-dose clopidogrel (P <0.001). Survival probability analysis revealed a higher survival rate with ticagrelor (9...