Safety and efficacy of low-dose ticagrelor in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention

Abstract

It remains unclear whether low-dose ticagrelor offers better safety and similar efficacy for Asian patients with acute coronary syndromes (ACS). We aimed to compare the safety and effectiveness of low-dose ticagrelor vs standard-dose ticagrelor in Chinese patients with ACS undergoing percutaneous coronary intervention (PCI). In this observational cohort study, a total of 2110 ACS patients who were event-free at 3 months after the index PCI were divided into standard-dose ticagrelor (90 mg twice daily) (n = 1830) or low-dose ticagrelor (45 mg twice daily) (n = 280) on a background of aspirin 100 mg once daily for at least another 9 months. The primary end point was type 2, 3, or 5 bleeding according to the Bleeding Academic Research Consortium (BARC) criteria over a 1-year follow-up period post-PCI. Predictors of the primary end point were identified. Both Cox regression and propensity score matching analyses were used. The cumulative incidence of BARC type 2, 3, or 5 bleeding was lower in the low-dose ticagrelor group vs the standard-dose group either before (adjusted HR 0.24; 95% CI 0.07–0.77; p = .016) or after matching (HR 0.25; 95% CI 0.08–0.85; p = .026). A composite of cardiac death, myocardial infarction, or stroke was not significantly different between the two groups (0.4% vs 0.9%, respectively). By multivariate analysis, only low-dose ticagrelor was a protected predictor of BARC type 2, 3, or 5 bleeding either before (HR 0.28, 95% CI 0.09–0.89) or after matching (HR 0.24, 95% CI 0.07–0.82). A low-dose regimen of ticagrelor might provide better safety than standard-dose ticagrelor in Chinese patients with ACS undergoing PCI.

Keywords:

• low-dose ticagrelor
• acute coronary syndrome
• percutaneous coronary intervention
• safety

Disclosure statement

Dr. Mintz receives grant support and/or honoraria from Boston Scientific, Philips, Terumo, and Medtronic. The other authors have no relevant financial or non-financial interests to disclose.

Additional information

Funding

This work was supported by Capitals’ s Funds for Health Improvement and Research of China (2018-2-2064), National Natural Science Foundations of China (NSFC, Grant No. 81670317 and 82071573) and, Science and technology key project of Beijing municipal education commission (KZ202010025045).