Impact of Baseline Bleeding Risk on Efficacy and Safety of Ticagrelor versus Clopidogrel in Chinese Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
查看参考文献21篇
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文摘
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Background: There was still conflict on the antithrombotic advantage of ticagrelor versus clopidogrel among East Asian population with acute coronary syndrome (ACS). We considered that the baseline bleeding risk might be an undetected key factor that significantly affected the efficacy of ticagrelor. Methods: A total of 20,816 serial patients who underwent percutaneous coronary intervention (PCI) from October 2011 to August 2014 in the General Hospital of Shenyang Military Region were enrolled in the present study. Patients receiving ticagrelor or clopidogrel were further subdivided according to basic bleeding risk. The primary outcome was net adverse clinical events (NACEs) defined as major adverse cardiac or cerebral events (MACCE, including all-cause death, myocardial infarction, ischemia-driven target vessel revascularization, or stroke) and any bleeding during 1-year follow-up. Comparison between ticagrelor and clopidogrel was adjusted by propensity score matching (PSM). Results: Among the 20,816 eligible PCI patients who were included in this study, there were 1578 and 779 patients in the clopidogrel and ticagrelor groups, respectively, after PSM, their clinical parameters were well matched. Patients receiving ticagrelor showed comparable NACE risk compared with those treated by clopidogrel (5.3% vs. 5.1%,P = 0.842). Furthermore, ticagrelor might reduce the MACCE risk in patients with low bleeding risk but increase MACCE in patients with moderate-to-high bleeding potential (ticagrelor vs. clopidogrel, low bleeding risk: 2.5% vs. 4.9%, P = 0.022; moderate-to-high bleeding risk: 4.8% vs. 3.0%, P = 0.225; interaction P = 0.021), with vast differences in all bleeding (low bleeding risk: 1.5% vs. 0.8%, P = 0.210; moderate-to-high bleeding risk: 4.8% vs. 3.0%, P = 0.002; interaction P = 0.296). Conclusion: Among real-world Chinese patients with ACS treated by PCI, ticagrelor only showed superior efficacy in patients with low bleeding risk but lost its advantage in patients with moderate-to-high bleeding potential. |
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来源
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Chinese Medical Journal
,2018,131(17):2017-2024 【核心库】
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DOI
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10.4103/0366-6999.239306
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关键词
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Baseline Bleeding Risk
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Clopidogrel
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Crusade Score
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Efficacy
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Ticagrelor
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地址
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Department of Cardiology, General Hospital of Shenyang Military Region, Liaoning, Shenyang, 110016
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语种
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英文 |
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文献类型
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研究性论文 |
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ISSN
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0366-6999 |
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学科
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医药、卫生 |
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基金
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sponsored by a grant from the National Key Research and Development Project
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文献收藏号
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CSCD:6311999
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参考文献 共
21
共2页
|
|
1.
Authors/Task Force Members. 2014 ESC/EACTS guidelines on myocardial revascularization: The task force on myocardial revascularization of the European Society Of Cardiology (ESC) and the European association for cardio-thoracic surgery (EACTS) Developed with the special contribution of the European association of percutaneous cardiovascular interventions (EAPCI).
Eur Heart J,2014,35:2541-2619
|
被引
151
次
|
|
|
|
|
2.
Levine G N. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: An update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction.
J Am Coll Cardiol,2016,67:1235-1250
|
被引
42
次
|
|
|
|
|
3.
Wallentin L. Ticagrelor versus clopidogrel in patients with acute coronary syndromes.
N Engl J Med,2009,361:1045-1057
|
被引
201
次
|
|
|
|
|
4.
Steg P G. Ticagrelor versus clopidogrel in patients with ST-elevation acute coronary syndromes intended for reperfusion with primary percutaneous coronary intervention: A Platelet inhibition and patient outcomes (PLATO) trial subgroup analysis.
Circulation,2010,122:2131-2141
|
被引
19
次
|
|
|
|
|
5.
Sahlen A. Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction: Experiences from SWEDEHEART registry.
Eur Heart J,2016,37:3335-3342
|
被引
5
次
|
|
|
|
|
6.
Goto S. Ticagrelor vs. Clopidogrel in Japanese, Korean and Taiwanese patients with acute coronary syndrome - Randomized, double-blind, phase III PHILO study.
Circ J,2015,79:2452-2460
|
被引
10
次
|
|
|
|
|
7.
Wu B. Ticagrelor versus clopidogrel in East-Asian patients with acute coronary syndromes: A meta-analysis of randomized trials.
J Comp Eff Res,2018,7:281-291
|
被引
3
次
|
|
|
|
|
8.
Lee C H. Cardiovascular and bleeding risks in acute myocardial infarction newly treated with ticagrelor vs. Clopidogrel in Taiwan.
Circ J,2018,82:747-756
|
被引
5
次
|
|
|
|
|
9.
Chen I C. Efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome in Taiwan: A multicenter retrospective pilot study.
J Chin Med Assoc,2016,79:521-530
|
被引
4
次
|
|
|
|
|
10.
Hamon M. Prognostic impact of major bleeding in patients with acute coronary syndromes. A systematic review and meta-analysis.
Eurolntervention,2007,3:400-408
|
被引
2
次
|
|
|
|
|
11.
Cornara S. Prognostic impact of in-hospital-bleeding in patients with ST-elevation myocardial infarction treated by primary percutaneous coronary intervention.
Am J Cardiol,2017,120:1734-1741
|
被引
3
次
|
|
|
|
|
12.
Levine G N. Expert consensus document: World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI.
Nat Rev Cardiol,2014,11:597-606
|
被引
22
次
|
|
|
|
|
13.
Kang H J. Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: A retrospective analysis from the platelet inhibition and patient outcomes (PLATO) trial.
Am Heart J,2015,169:899-905.el
|
被引
14
次
|
|
|
|
|
14.
Wang X. Switching between ticagrelor and clopidogrel in patients who underwent percutaneous coronary intervention: Insight into contemporary practice in Chinese patients.
Eur Heart J Suppl,2016,18:F19-F26
|
被引
3
次
|
|
|
|
|
15.
Subherwal S. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: The CRUSADE (Can rapid risk stratification of unstable angina patients suppress ADverse outcomes with early implementation of the ACC/AHA guidelines) bleeding score.
Circulation,2009,119:1873-1882
|
被引
46
次
|
|
|
|
|
16.
Mehran R. Standardized bleeding definitions for cardiovascular clinical trials: A consensus report from the bleeding academic research consortium.
Circulation,2011,123:2736-2747
|
被引
135
次
|
|
|
|
|
17.
Wang H. Pharmacodynamics and pharmacokinetics of ticagrelor vs. Clopidogrel in patients with acute coronary syndromes and chronic kidney disease.
Br J Clin Pharmacol,2018,84:88-96
|
被引
5
次
|
|
|
|
|
18.
Teng R. Pharmacokinetics, pharmacodynamics, and tolerability of single and multiple doses of ticagrelor in Japanese and caucasian volunteers.
Int J Clin Pharmacol Ther,2014,52:478-491
|
被引
8
次
|
|
|
|
|
19.
Kwon T J. Influence of platelet reactivity on BARC classification in East Asian patients undergoing percutaneous coronary intervention. Results of the ACCEL-BLEED study.
Thromb Haemost,2016,115:979-992
|
被引
1
次
|
|
|
|
|
20.
Yeh R W. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention.
JAMA,2016,315:1735-1749
|
被引
14
次
|
|
|
|
|
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