Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in Elderly Patients Undergoing Percutaneous Coronary Intervention: A Cohort Study

Abstract

Background

Age is a strong predictor of adverse outcomes due both to a higher risk of bleeding and ischemia. The purpose of this study was to evaluate the safety and efficacy of ticagrelor in elderly patients.

Methods

Patients ≥75 years of age admitted to our center from January, 2015 to December, 2019 who had undergone percutaneous coronary intervention (PCI) and received dual antiplatelet therapy (DAPT) were included in our study. Eligible patients were divided into clopidogrel and ticagrelor groups according to the P2Y₁₂ receptor inhibitor and were followed up for 1 year. The primary safety endpoint was types 2, 3, and 5 bleeding, as defined by Bleeding Academic Research Consortium (BARC), and the primary efficacy endpoint was combined major adverse cardiovascular and cerebrovascular events (MACCEs). A Cox proportional hazard model and propensity score matching were used to correct confounding factors.

Results

Of 1505 patients enrolled in this study, 442 were assigned to ticagrelor group and 1063 were assigned to clopidogrel group. The incidence of BARC 2, 3, and 5 bleeding (HR, 2.304; 95% CI, 1.540–3.447), and any bleeding (HR, 2.476; 95% CI, 1.802–3.403) in ticagrelor group was significantly higher than clopidogrel group. There were no significant difference between the two groups with respect to BARC 3 and 5 bleeding (HR, 1.566; 95% CI, 0.767–3.198) and MACCEs (HR, 0.957; 95% CI, 0.702–1.305).

Conclusion

Compared with clopidogrel, DAPT with ticagrelor significantly increased the risk of BARC 2, 3, and 5 bleeding without reducing MACCEs in elderly patients who underwent PCI.

Trial Registration

The study was retrospectively registered in clinicaltrials.gov (NCT 04999293).

Keywords:

• ticagrelor
• elderly
• percutaneous coronary intervention
• dual antiplatelet therapy

Data Sharing Statement

The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Acknowledgments

The authors thank Dr Xuhe Gong, Dr Mingyuan Liu, Dr Jixuan Liu (Beijing Friendship Hospital, Capital Medical University) for their help in the design of this study. Shaoke Meng and Lei Guo share first authorship.

Disclosure

The authors declare that they have no conflict of interest.

Additional information

Funding

This study was supported by the Beijing United Heart Foundation, Cardiacare Sponsored Optimizing Antithrombotic Research Fund (grant no. BJUHFCSOARF 201801-02) (Beijing,China).