title: Comparison of short-term clinical outcomes between ticagrelor versus clopidogrel in patients with acute myocardial infarction undergoing successful revascularization; from Korea Acute Myocardial Infarction Registry-National Institute of Health.
abstract: BACKGROUND
  Although ticagrelor has been well-known to improve clinical outcomes in patients with acute myocardial infarction (AMI) without increased bleeding risk, its clinical impacts have not been well established in East Asian patients.
  
  
  METHODS
  Between November 2011 and June 2015, a total of 8010 patients (1377 patients were prescribed ticagrelor and 6633 patients clopidogrel) undergoing successful revascularization were analyzed from Korea Acute Myocardial Infarction Registry-National Institute of Health. The patients who discontinued or occurred in-hospital switching between two antiplatelet agents were excluded.
  
  
  RESULTS
  After propensity score matching (1377 pairs), no difference in the composite of cardiac death, MI, stroke, or target vessel revascularization at 6months was observed between two groups (4.2% vs. 4.9%, p=0.499). However, the incidences of in-hospital Thrombolysis In Myocardial Infarction (TIMI) major and minor bleeding were higher in ticagrelor than clopidogrel (2.6% vs. 1.2%, p=0.008; 3.8% vs. 2.5%, p=0.051). The in-hospital mortality was higher in patients with than those without TIMI major bleeding (11.3% vs. 0.9%, p<0.001). In a subgroup analysis, a higher risk for in-hospital TIMI major bleeding with ticagrelor was observed in patients≥75years or with body weight<60kg (odd ratio [OR]=3.209; 95% confidence interval [CI]=1.356-7.592) and in those received trans-femoral intervention (OR=1.996; 95% CI=1.061-3.754).
  
  
  CONCLUSIONS
  Our study shows that ticagrelor did not reduce ischemic events yet, however, was associated with increased risk of bleeding complications compared with clopidogrel. Further large-scale, long-term, randomized trials should be required to assess the outcomes of ticagrelor for East Asian patients with AMI.
authors.affiliation: Chosun University Hospital, Gwangju, Republic of Korea.
authors.forename: Keun-Ho
authors.initials: KH
authors.lastname: Park
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: Gachon University Gil Medical Center, Incheon, Republic of Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Ahn
authors.affiliation: The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea.
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.affiliation: Korea University Guro Hospital, Seoul, Republic of Korea.
authors.forename: Dong Joo
authors.initials: DJ
authors.lastname: Oh
authors.affiliation: Seoul National University Bundang Hospital, Seoul, Republic of Korea.
authors.forename: Dong-Joo
authors.initials: DJ
authors.lastname: Choi
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Sungkyunkwan Universtiy Samsung Medical Center, Seoul, Republic of Korea.
authors.forename: Hyeon Cheol
authors.initials: HC
authors.lastname: Gwon
authors.affiliation: hungnam National Universtiy Hospital, Daejeon, Republic of Korea.
authors.forename: In Whan
authors.initials: IW
authors.lastname: Seong
authors.affiliation: Chungbuk National University Hospital, Cheongju, Republic of Korea.
authors.forename: Kyung Kuk
authors.initials: KK
authors.lastname: Hwang
authors.affiliation: Kyungpook National University Hospital, Daegu, Republic of Korea.
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.affiliation: Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
authors.forename: Kwon-Bae
authors.initials: KB
authors.lastname: Kim
authors.affiliation: Yeungnam University Hospital, Daegu, Republic of Korea.
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Kwang Soo
authors.initials: KS
authors.lastname: Cha
authors.affiliation: Wonkwang University Hospital, Iksan, Republic of Korea.
authors.forename: Seok Kyu
authors.initials: SK
authors.lastname: Oh
authors.affiliation: Chonbuk National University Hospital, Jeonju, Republic of Korea.
authors.forename: Jei Keon
authors.initials: JK
authors.lastname: Chae
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000077144:Clopidogrel; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D012042:Registries; D056910:Republic of Korea; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: Far East; Hemorrhage; Myocardial infarction; Ticagrelor