title: Ticagrelor vs. clopidogrel in non-ST-elevation acute coronary syndromes.
abstract: OBJECTIVE
  The aim of this study was to evaluate the bradyarrhythmic events associated with ticagrelor combination therapy in the management of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI).
  
  
  METHODS
  The study comprised 300 patients with NSTEMI who were treated via percutaneous coronary intervention (PCI). Patients were randomly assigned to two groups: the clopidogrel group (initial dose of 300 mg and then maintenance dose of 75 mg once daily, n = 151) and the ticagrelor group (initial dose of 180 mg and then maintenance dose of 90 mg twice daily, n = 149). All patients were followed up in the outpatient clinic. Follow-up included 12-lead electrocardiography and 24-h Holter monitoring performed 1, 6, and 12 months after the revascularization procedure.
  
  
  RESULTS
  Of the 300 patients, 112 patients (36.7 %) had a decrease in heart rate at the 12-month follow-up. Of these, 80 patients were in the ticagrelor group (53.3 %) vs. 32 patients in the clopidogrel group (24.7 %; p < 0.05). However, the difference was not statistically significant at the 1-month and 6-month follow-up visits. After adjusting for potential confounders, the reduction in heart rate with ticagrelor combination therapy remained independently associated with a reduced risk of major adverse cardiovascular events (hazard ratio, 2.1; 95 % CI, 1.90-2.23), while ticagrelor therapy reduced the risk to a level equivalent to that of patients in the clopidogrel group.
  
  
  CONCLUSIONS
  Ticagrelor can lower the resting heart rate of patients and cause bradyarrhythmias in the 12th month after PCI.
authors.affiliation: Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University, No. 324, Jingwu Road, Jinan, China.|Department of Cardiology, Jining No. 1 People's Hospital, Jining, Shandong, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Ren
authors.affiliation: Department of Cardiology, Jining No. 1 People's Hospital, Jining, Shandong, China.
authors.forename: C
authors.initials: C
authors.lastname: Ren
authors.affiliation: Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University, No. 324, Jingwu Road, Jinan, China.
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Jining No. 1 People's Hospital, Jining, Shandong, China.
authors.forename: C
authors.initials: C
authors.lastname: Dong
authors.affiliation: Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University, No. 324, Jingwu Road, Jinan, China. zhangxinghua0531@126.com.
authors.forename: X
authors.initials: X
authors.lastname: Zhang
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality*; D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D001919:Bradycardia / Q000139:chemically induced / Q000401:mortality; D000077144:Clopidogrel; D015897:Comorbidity; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D000072658:Non-ST Elevated Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D015995:Prevalence; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage; D012307:Risk Factors; D015996:Survival Rate; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: Bradyarrhythmia; Clopidogrel; Coronary artery disease; Non-ST-segment MI; Ticagrelor