Real-world data on potent P2Y12-inhibition in patients with suspected chronic coronary syndrome, referred for coronary angiography

Abstract

Introduction Potential benefit with potent platelet inhibition in patients with chronic coronary syndrome (CCS), undergoing percutaneous coronary intervention (PCI) has been discussed. The aim of this study was to compare a potent P2Y12 inhibition strategy using ticagrelor with clopidogrel, in CCS patients referred for coronary angiography (CA) and PCI if feasible. Methods In this retrospective real-world study, patients referred for outpatient CA due to suspected CCS were included. To adjust for group differences, a propensity score reflecting the probability of being treated with ticagrelor was calculated and added to the logistic regression outcome model. Results In total 1 003 patients were included in the primary analysis (577 treated with clopidogrel and 426 with ticagrelor). Among clopidogrel treated patients 132 (22.9%) experienced a bleeding complication compared with 93 (21.8%) among ticagrelor treated patients, with no significant difference between the groups (p=0.70). There was no difference in bleeding severity. Furthermore, we observed no statistically significant difference in major adverse cardiovascular event (MACE [death, stent thrombosis, myocardial infarction or stroke]), (1.2% vs 2.3%, p=0.17). A subgroup analysis restricted to patients undergoing PCI ad hoc displayed a similar pattern. Also patients undergoing CA without PCI ad hoc frequently experienced a bleeding complication, with no difference between the two treatments (21.0 % vs 17.3%, p=0.27). Propensity score adjusted analyses confirmed the results. Discussion/Conclusion In patients with CCS referred for CA and PCI if feasible, a more potent P2Y12 inhibition strategy with ticagrelor was not associated with bleeding complications or MACE compared with clopidogrel.

The Author(s). Published by S. Karger AG, Basel

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