(223) Comparing the Clinical Outcomes of Ticagrelor versus Clopidogrel in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary PCI in Qatar: A Retrospective Cohort Study Using Real-World Data
Professor and Head of Department Qatar University College of Pharmacy Doha, Qatar
Background: There is limited data comparing the clinical outcomes of different P2Y12 inhibitors in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
Objectives: To compare the efficacy and safety of ticagrelor versus clopidogrel in patients with STEMI who underwent PCI.
Methods: In this retrospective cohort study, data were collected from electronic medical records of eligible STEMI patients discharged after PCI between 1 January 2015 and 31 December 2016 from Heart Hospital, Qatar. The primary outcomes were occurrence of cardiovascular (CV) related death, myocardial infarction (MI), stroke/transient ischemic attack (TIA), stent-related thrombosis, rehospitalization, major/minor bleeding, GI bleeding, and intracranial hemorrhage (ICH). Outcomes were evaluated using logistic regression analyses after adjustment for independent risk factors. Adjusted odds ratios (aOR) with 95% CI were calculated and p-value of < 0.05 was considered statistically significant.
Results: Eight hundred sixty-seven patients were included in the analyses. There were no significant differences between clopidogrel and ticagrelor groups in the risk of CV-related mortality (aOR=10298622, P=0.997), stent-related thrombosis (aOR=0.301, P=0.16), stroke/TIA (aOR=1.338, P=0.788), rehospitalization (aOR=0.613, P=0.268), major/minor bleeding (aOR=0.35, P=0.082), and ICH (aOR=0.0295, P=0.358). However, clopidogrel was associated with significantly lower risk of MI (aOR=0.47, P=0.031) and GI bleeding (aOR=0.11, P=0.004), respectively.
Conclusions: In patients with STEMI who underwent PCI, the incidence of MI and GI bleeding were significantly lower among those who received clopidogrel compared to those who received ticagrelor. Other outcomes were not significantly different between the two groups.
