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Yang N, Liu J, Liu J, Hao Y, Smith JSC, Huo Y, Fonarow GC, Ge J, Morgan L, Ma C, Han Y, Zhao D, Li B, Xu B, Li B, Liu B, Wang B, He Y, Yu B, Yang B, Luo C, Wang C, Liu C, Liang C, Gao C, Lai C, Wang C, Zhang C, Wu C, Zhang C, Cui B, Huang L, Peng D, Xu D, Wu D, Zhu D, Chai D, Li D, Tang F, Xiao J, Zhao F, Huang F, Meng F, Li F, Gan F, Xu G, Sang G, Ma G, Zhang G, Tao G, Li G, Chen G, Xin G, Li G, Fu G, Chen G, Lin H, Guo H, Lin H, Jiang H, Liu H, Luan H, Zhang H, Deng H, Li H, Wang H, Liu H, Dong H, Liu H, Zhang H, Wang H, Chu H, Xi J, Yang J, Ye J, Li J, Tao J, Liu J, Yang J, Ding J, Tong J, Chen J, Jiang J, Yang J, Li J, Yan J, Hu J, Xu J, Wang J, Diao J, Zhao J, Wei J, Yi J, Su J, Tang J, Chen J, Yin J, Fan J, Guan J, Ge J, Liu J, Deng J, Fang J, Li J, Chen K, Luo K, Wu K, Hong L, Li L, Jiang L, Wei L, Meng L, Ma L, Tang L, Wang L, Wei L, Li L, Tao L, Yang L, Li W, Zhang M, Chen K, Lai M, Tian M, Bai M, Han M, Chen M, Liang N, Jia N, Bing H, Qu P, Zhang P, Chen P, Hou P, Xie P, Zhang P, Dong P, Wu Q, Xie Q, Zhong Q, Wang Q, Su Q, Chang R, Lin R, Zhao R, Jia S, Nie S, Ye S, He S, Chen S, Ma S, Li S, Xin S, Xia S, Zhang S, Qu S, Ma S, Wang S, Li S, Luo S, Liu T, Zhang T, Tuo T, Li T, Yang T, Du T, Wu T, Liu W, Mao W, Tuo W, Wang W, Jiang W, Huang W, Liu W, Fan W, Xu W, Lin W, Su X, Chen X, Zhang X, Fu X, Yang X, Zhao X, Ma X, Sun X, Wang X, Li X, Li X, Yang X, Chen X, Chen X, Zhang X, Cheng X, Peng X, Ma X, Qi X, Feng X, Chen X, Tang X, Tang S, Zhao X, Chen X, Li X, Li X, Liu X, Peng X, Han Y, Wang Y, Niu Y, Yu Y, Zheng Y, Wang Y, Zheng Y, Guo Y, Yang Y, Huang Y, Liu Y, Guo Y, Luo Y, Hao Y, Sun Y, Lin Y, Ma Y, Guo Y, Li Y, Li Y, Zhang Y, Jin Y, Li Y, Huang Y, Sun Y, Yang Y, Zhu Y, Shi Y, Zhao Y, Hou Y, Zheng Z, Xu Z, Ouyang Z, He Z, Lv Z, Li Z, He Z, Ji Z, Zhang Z, Ji Z, Su Z, Yang Z, Ou Z, Yang Z, Yang Z, Wang Z, Song Z, Wang Z, Yuan Z. In-hospital outcomes of ticagrelor versus clopidogrel in patients 75 years or older with acute coronary syndrome: findings from the Improving Care for Cardiovascular Disease in China (CCC)-Acute Coronary Syndrome Project. Age Ageing 2022; 51:6827082. [PMID: 36413586 DOI: 10.1093/ageing/afac231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The evidence for the comparative effectiveness and safety of ticagrelor versus clopidogrel in older patients with acute coronary syndrome (ACS) is limited, especially in the acute phase of ACS. This study aimed to compare the in-hospital outcomes of ticagrelor versus clopidogrel in older patients with ACS. METHODS Hospitalised ACS patients aged ≥75 years who were recruited to the Improving Care for Cardiovascular Disease in China-ACS project between November 2014 and December 2019 and received aspirin and P2Y12 receptor inhibitors within 24 h after first medical contact were included. The primary outcomes were in-hospital major adverse cardiovascular events (MACE) and major bleeding. Multivariable Cox regression was performed to evaluate the comparative effectiveness and safety of ticagrelor and clopidogrel. Inverse probability of treatment weighting (IPTW) and propensity score matching analyses were performed to evaluate the robustness of the results. RESULTS Of 18,244 ACS patients, 18.5% received ticagrelor. Multivariable-adjusted analysis revealed comparable risks of in-hospital MACE between patients receiving ticagrelor and clopidogrel (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.92-1.35). However, ticagrelor use was associated with 45% higher risk of in-hospital major bleeding compared with clopidogrel use (HR 1.45, 95% CI 1.09-1.91). Similar results were found in the IPTW analysis. CONCLUSIONS ACS patients aged ≥75 years receiving ticagrelor during the acute phase had similar risk of in-hospital MACE, but higher risk of in-hospital major bleeding compared with those receiving clopidogrel. More evidence is needed to guide the use of P2Y12 receptor inhibitors during hospitalisation in older patients with ACS. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02306616.
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Affiliation(s)
- Na Yang
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yongchen Hao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jr Sidney C Smith
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Gregg C Fonarow
- Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Louise Morgan
- International Quality Improvement Department, American Heart Association, Dallas, TX, USA
| | - Changsheng Ma
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Yaling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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