Potent P2Y12 inhibitors plus ASA significantly reduced the 6-month composite of thrombotic or bleeding events compared to clopidogrel plus ASA (0% vs 14%, p=0.033).
Cohort (n=100)
No
Do potent P2Y12 inhibitors (ticagrelor or prasugrel) reduce thrombotic or bleeding events compared to clopidogrel in patients at high ischemic and low bleeding risk undergoing PCI for chronic coronary syndromes?
In patients with chronic coronary syndromes at high ischemic and low bleeding risk undergoing PCI, potent P2Y12 inhibitors (ticagrelor or prasugrel) combined with aspirin significantly reduced the composite of thrombotic or bleeding events at 6 months compared to clopidogrel.
Absolute Event Rate: 0% vs 14%
p-value: p=0.033
Abstract Background Dual antiplatelet therapy (DAPT) is a standard treatment in patients undergoing percutaneous coronary intervention (PCI) for chronic coronary syndromes (CCS) to reduce recurrent ischaemic events. Although acetylsalicylic acid (ASA) and clopidogrel are the mainstay therapy, we know that personalisation of the treatment based on the patient's individual ischaemic and bleeding risk factors may improve the outcomes. The optimal antiplatelet treatment strategy for patients with high ischaemic and low bleeding risk remains uncertain, with preliminary registry-based data suggesting that potent P2Y12 inhibitors may be more efficient in this scenario. Purpose We compared the efficacy and safety of ticagrelor or prasugrel versus clopidogrel in patients at high ischaemic and low bleeding risk undergoing PCI for CCS. Methods In this retrospective cohort study patients undergoing PCI for CCS between January 2023 and October 2024 at tertiary centre were enrolled. All patients met the ESC criteria for high ischaemic and low bleeding risk. Patients were retrospectively divided into two groups based on the post-PCI DAPT pattern. The first group was administered ASA (75 mg daily) and ticagrelor (180 mg daily) or prasugrel (60 mg daily) and the second group was treated with ASA (75 mg daily) and clopidogrel (75 mg daily), based on the operator’s discretion. The primary endpoint was a composite of any thrombotic or bleeding events at 6 months after PCI. Secondary endpoints included the individual components of primary endpoint including death from any cause, myocardial infarction, ischaemic stroke, in-stent thrombosis, target lesion revascularization and major bleeding events. Results Among 100 patients included in the analysis, 29 patients received ASA+ticagrelor/prasugrel (29%) and 71 received ASA+clopidogrel (71%). The composite endpoint occurred in none of the patients in ASA+ticagrelor/prasugrel group (0%) versus 10 of patients in ASA+clopidogrel group (14%) (p=0.033). There was no significant difference in secondary endpoints between the groups. Additional subgroup analyses depending on sex, age, concomitant diseases or periprocedural parameters failed to identify any factors associated with the occurrence of the endpoints. Conclusions Potent P2Y12 inhibitors may be more effective and safer compared to clopidogrel in patients at high ischaemic and low bleeding risk undergoing PCI for CCS.Graphical abstractFor image description, please refer to the figure legend and surrounding text. EndpointsFor image description, please refer to the figure legend and surrounding text.
Bochenek et al. (Sun,) conducted a cohort in Chronic coronary syndromes undergoing PCI (n=100). Ticagrelor or prasugrel plus ASA vs. Clopidogrel plus ASA (75 mg daily each) was evaluated on Composite of any thrombotic or bleeding events at 6 months after PCI (p=0.033). Potent P2Y12 inhibitors plus ASA significantly reduced the 6-month composite of thrombotic or bleeding events compared to clopidogrel plus ASA (0% vs 14%, p=0.033).