医学
替卡格雷
氯吡格雷
急性冠脉综合征
内科学
心脏病学
危险系数
P2Y12
比例危险模型
人口
冲程(发动机)
阿司匹林
心肌梗塞
置信区间
机械工程
环境卫生
工程类
作者
Şükrü Akyüz,Ali Nazmi Çalık,Barış Yaylak,Tolga Onuk,Semih Eren,Ercan Akşit,Feyza Mollaalioğlu,Furkan Durak,Mustafa Çetın,İbrahim Halil Tanboğa
标识
DOI:10.1016/j.amjcard.2023.10.046
摘要
Current guidelines recommend individualizing the choice and duration of P2Y12 inhibitor therapy based on the trade-off between bleeding and ischemic risk. However, whether a potent P2Y12 inhibitor (ticagrelor) or a less potent one (clopidogrel) is more appropriate in patients with acute coronary syndrome (ACS) in the setting of high bleeding or ischemic risk is not clear. The study aimed to compare the clinical outcomes of clopidogrel and ticagrelor in patients with ACS at high bleeding or ischemic risk. A total of 5,713 patients with ACS were included in this retrospective study. The Cox proportional hazard regression model was adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The primary clinical outcome was all-cause death. Secondary outcomes included in-hospital death, ACS, target vessel revascularization, stent thrombosis, stroke, or clinically significant or major bleeding. The median follow-up duration was 53.6 months. After multivariable Cox model using an inverse probability weighted approach, all-cause death in the overall population and subgroups of patients at high bleeding risk, and/or at high ischemic risk were not significantly different between clopidogrel and ticagrelor. Rates for secondary outcomes were also similar between the groups. In conclusion, ticagrelor and clopidogrel are associated with comparable clinical outcomes in patients with ACS irrespective of bleeding and ischemic risk.
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