- NEWS . 24 Jan 2020
Ticagrelor associated with 21% MACCE reduction compared to clopidogrel in elderly patients with STEMI
Researchers have confirmed the efficacy and safety of ticagrelor for elderly patients (≥75 years) with acute ST‐segment–elevation myocardial infarction (STEMI), compared with clopidogrel.
The researchers in Germany analysed STEMI Registry data between 2006 and 2017 for elderly patients. Of a total of 7,466 patients with STEMI, 1,087 aged ≥75 years were selected, of these 552 (51%) received clopidogrel and 535 (49%) received ticagrelor. Age (80.9±4.6 vs 80.9±4.6 years) and sex (51% vs 50% female) distributions were similar between treatment arms. The primary efficacy outcome, major adverse cardiac and cerebrovascular events (MACCE), was defined as a composite of death, myocardial re-infarction and stroke within 1 year after STEMI. The safety outcome was defined as any significant bleeding event within 1 year.
The primary efficacy outcome occurred in 32.4% of patients treated with clopidogrel versus 25.5% treated with ticagrelor (p=0.015). The 1‐year mortality rate was 26.8% versus 21.1%, respectively (p=0.035). Because there was no difference in the safety outcome (clopidogrel vs ticagrelor, 4.9% vs 5.1%; not significant), net adverse clinical events were higher for clopidogrel than for ticagrelor (37.3% vs 30.6%; p=0.028).
In a propensity score–matched model, the advantage for ticagrelor on MACCE remained significant (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.49–0.97; p=0.03), whereas 1‐year mortality (HR, 0.89; 95% CI, 0.67–1.27; p=0.5) and 1‐year bleeding events (HR, 1.1; 95% CI, 0.4–2.3; p=0.8) did not differ.
The findings suggest that ticagrelor should be preferred to clopidogrel in elderly STEMI patients undergoing emergency percutaneous coronary intervention when no contraindications are present.
Schmucker J, et al. Efficacy and safety of ticagrelor in comparison to clopidogrel in elderly patients with ST‐segment–elevation myocardial infarctions. JAMA 2019;8:e012530.