• 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.

    Reference:
    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.