Abstract
BACKGROUND: Although ticagrelor is recommended as opposed to clopidogrel in antiplatelet strategy for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI), evidence is limited in patients with cardiogenic shock (CS). OBJECTIVE: This study aims to evaluate the comparative efficacy and safety profile of ticagrelor and clopidogrel in patients with STEMI-CS undergoing pPCI. METHODS: Using data from a nationwide, multicenter registry, eligible patients were stratified into clopidogrel or ticagrelor based on the choice of P2Y(12) inhibitors within 24 h of first medical contact. Multivariable-adjusted Cox regression analyses, along with Cox models adjusted for propensity score matching and inverse probability treatment weighting were conducted to compare outcomes between ticagrelor and clopidogrel. The efficacy and safety outcomes were in-hospital all-cause mortality and major bleeding. RESULTS: Among 729 STEMI-CS patients in our cohort, 403 received clopidogrel and 326 received ticagrelor. Multivariable-adjusted Cox regression analyses showed that ticagrelor was not associated with a significant difference in all-cause mortality (adjusted HR: 1.04; 95% CI: 0.69-1.56; p = 0.840) and major bleeding (adjusted HR: 1.30; 95% CI: 0.62-2.76; p = 0.489) compared to clopidogrel. Consistent results were found in the analyses adjusted by propensity score matching and inverse probability of treatment weighting. CONCLUSIONS: Our findings suggest that the choice of either ticagrelor or clopidogrel was feasible as a P2Y(12) inhibitor for dual anti-platelet strategy in STEMI-CS patients undergoing pPCI, as no significant difference between these two agents was observed in all-cause mortality and major bleeding during hospitalization. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02306616. Registered 29 November 2014.