ТИКАГРЕЛОР НЕ ЛУЧШЕ КЛОПИДОГРЕЛА В КИТАЙСКОЙ ПОПУЛЯЦИИПАЦИЕНТОВ С ОКС. РЕЗУЛЬТАТЫ ИССЛЕДОВАНИЯ COSTIC

В исследование включено 3 500 больных с окс. Показано , что терапия тикагрелора не привела к значимому снижению событий. При этом отмечено достоверное повышение риска кровотечений
roduction: Acute coronary syndrome (ACS) is one of the leading causes of mortality globally. Percutaneous coronary intervention (PCI) is a widely used technique to overcome this condition. However, PCI is associated with increased risk of thrombosis for which P2Y12 inhibitors like clopidogrel or ticagrelor in combination with aspirin are recommended.

Purpose: To evaluate the short- and long-term effectiveness and safety of clopidogrel versus ticagrelor in Chinese ACS patients who have undergone PCI.

Methods: A total of 3587 patients diagnosed with ACS undergoing PCI were included between August 2014 and January 2017 for this ongoing prospective, single-centre registry study (NCT03239067). The primary effectiveness endpoints were vascular death, myocardial infarction (MI) and stroke. Death due to all cause for the mentioned primary endpoints were reported as secondary endpoint. For the safety endpoint, Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria was taken as a reference. KM survival curves were constructed to compare the effectiveness and safety between groups, accompanied by multivariate Cox regression models.

Results: The primary effectiveness endpoint between the two treatment groups (ticagrelor vs. clopidogrel) at 7 days (adjusted P=0.75), 1 month (adjusted P=0.10) or 6 months (adjusted P=0.75) did not vary significantly. Ticagrelor treatment increased the risk of minor bleeding compared to clopidogrel at 7-day [1.1% vs. 0.4%, hazard ratio (HR) = 2.47, 95% CI: 1.10–5.53], 1-month (1.3% vs. 0.5%, HR=2.50, 95% CI: 1.20–5.17) and 6-month time point (1.6% vs. 0.8%, HR=2.04, 95% CI: 1.09–3.82). The occurrence of major bleeding events was significantly higher in ticagrelor arm at 6-month time point (P=0.04) along with minimal bleeding events at 1-month and 6 –month time point (P<0.001).

Conclusion: Treatment with ticagrelor did not significantly reduce the risk of vascular death, MI or stroke when compared to clopidogrel in Chinese patients with ACS undergoing PCI. Although both drugs are efficient in reducing the burden of ACS, treatment with ticagrelor was accompanied with significantly more frequent bleeding events when compared to clopidogrel.

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