Comparison of In-Hospital Major Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction Treated with Ticagrelor or Clopidogrel in the Emergency Department: A Propensity Score Matched Retrospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Data Collection
2.3. Outcome Measurement
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Drug | p-Value | |
---|---|---|---|
Clopidogrel (n = 772) | Ticagrelor (n = 929) | ||
Age, mean ± SD | 65.63 ± 13.49 | 59.37 ± 13.08 | <0.001 a |
Sex (%): | <0.001 b | ||
Male | 555 (71.89) | 764 (82.24) | |
Female | 217 (28.11) | 165 (17.76) | |
Clinical history (%): | |||
Smoking | 369 (47.80) | 537 (57.80) | <0.001 b |
Hypertension | 483 (62.56) | 509 (54.79) | 0.001 b |
Diabetes mellitus | 337 (43.65) | 295 (31.75) | <0.001 b |
Coronary artery disease | 228 (29.53) | 156 (16.79) | <0.001 b |
Cerebrovascular disease | 61 (7.90) | 27 (2.91) | <0.001 b |
Chronic kidney disease | 174 (22.54) | 87 (9.36) | <0.001 b |
Hyperlipidemia | 41 (5.31) | 85 (9.15) | 0.002 b |
Presentation features: | |||
Killip class | |||
Level 2–Level 4 | 182 (23.58) | 145 (15.61) | <0.001 b |
Systolic BP (SBP) | 136.5 ± 39.21 | 135.2 ± 32.56 | 0.472 a |
Diastolic BP (DBP) | 83.55 ± 26.71 | 86.06 ± 22.75 | 0.039 a |
Heart rate, bpm | 85.96 ± 27.09 | 83.27 ± 22.56 | 0.028 a |
Peak troponin I, ng/mL | 5.19 ± 11.53 | 3.60 ± 9.36 | 0.002 a |
GFR | 54.10 ± 34.35 | 67.52 ± 27.88 | <0.001 a |
Creatinine | 2.64 ± 3.10 | 1.67 ± 3.88 | <0.001 a |
LVEF | 49.99 ± 12.17 | 50.36 ± 11.23 | 0.535 a |
Angiographic findings: | |||
Left main disease * | 54 (6.99) | 56 (6.03) | 0.419 b |
No. of disease vessels * | 0.107 b | ||
1 | 355 (45.98) | 445 (47.90) | |
2 | 250 (32.38) | 293 (31.54) | |
3 | 111 (14.38) | 148 (15.93) | |
No. of disease vessels * | 0.374 b | ||
<3 | 661 (85.62) | 781 (84.07) | |
≥3 | 111 (14.38) | 148 (15.93) | |
Type: | <0.001 b | ||
STEMI | 292 (37.82) | 543 (58.45) | |
NSTEMI | 480 (62.18) | 386 (41.55) |
Variables | Drug | p-Value | |
---|---|---|---|
Clopidogrel (n = 772) | Ticagrelor (n = 929) | ||
In-hospital MACE (%): | <0.001 a | ||
No | 714 (92.49) | 901 (96.99) | |
Stroke | 10 (1.30) | 5 (0.54) | |
Recurrent MI | 1 (0.13) | 2 (0.22) | |
Unplanned repeat PCI | 3 (0.39) | 1 (0.11) | |
Death | 44 (5.70) | 20 (2.15) | |
72 h ED return (%): | 0.096 a | ||
No | 768 (99.48) | 925 (99.57) | |
Planned | 0 (0.00) | 3 (0.32) | |
Unplanned | 4 (0.52) | 1 (0.11) | |
14 days readmission (%): | 0.096 a | ||
No | 755 (97.80) | 919 (98.92) | |
Planned | 8 (1.04) | 7 (0.75) | |
Unplanned | 9 (1.17) | 3 (0.32) | |
PCI performed within 30 days | 106 (13.73) | 160 (17.22) | 0.048 a |
CABG performed within 30 days | 5 (0.65) | 10 (1.08) | 0.346 a |
Parameters | Univariate | Multivariate | ||
---|---|---|---|---|
OR (95% CI) | p-Value | OR (95% CI) | p-Value | |
Age | 1.06 (1.04–1.08) | <0.001 | 1.05 (1.03–1.07) | <0.001 |
Sex, Male | 0.65 (0.41–1.05) | 0.078 | 1.16 (0.66–2.04) | 0.604 |
Drug: | ||||
clopidogrel | Reference | - | Reference | - |
ticagrelor | 0.38 (0.24–0.61) | <0.001 | 0.53 (0.32–0.88) | 0.013 |
Clinical history: | ||||
Smoking | 0.53 (0.34–0.83) | 0.005 | 0.86 (0.50–1.46) | 0.567 |
Hypertension | 1.60 (1.01–2.55) | 0.048 | 1.12 (0.66–1.89) | 0.677 |
Diabetes mellitus | 1.58 (1.02–2.44) | 0.039 | 1.08 (0.66–1.77) | 0.769 |
Coronary artery disease | 1.27 (0.78–2.07) | 0.343 | ||
Cerebrovascular disease | 3.28 (1.71–6.30) | <0.001 | 1.75 (0.84–3.64) | 0.133 |
Chronic kidney disease | 1.18 (0.66–2.09) | 0.579 | ||
Hyperlipidemia | 0.76 (0.30–1.92) | 0.564 | ||
Presentation features: | ||||
Killip class | ||||
Level 1 | Reference | - | Reference | - |
Level 2–Level 4 | 6.37 (4.08–9.95) | <0.001 | 3.77 (2.32–6.11) | <0.001 |
Systolic BP (SBP) | 0.99 (0.98–0.99) | <0.001 | 0.99 (0.98–0.99) | 0.001 |
Diastolic BP (DBP) | 0.98 (0.97–0.99) | <0.001 | ||
Heart rate | 1.00 (0.99–1.01) | 0.365 | ||
Peak troponin I | 1.02 (1.01–1.04) | 0.001 | 1.02 (1.01–1.03) | 0.027 |
Angiographic findings: | ||||
Left main disease * | 2.25 (1.16–4.37) | 0.017 | 1.82 (0.87–3.82) | 0.110 |
No. of disease vessels * | ||||
<3 | Reference | - | ||
≥3 | 1.63(0.96–2.75) | 0.071 | ||
Type: | ||||
NSTEMI | Reference | - | Reference | - |
STEMI | 1.71 (1.10–2.67) | 0.018 | 2.39 (1.43–3.98) | <0.001 |
Variables | Drug | SMD | |
---|---|---|---|
Clopidogrel (n = 588) | Ticagrelor (n = 588) | ||
Age, mean ± SD | 63.63 ± 13.52 | 63.06 ± 12.72 | −0.043 |
Sex (%): | 0.048 | ||
Male | 445 (75.68) | 457 (77.72) | |
Female | 143 (24.32) | 131 (22.28) | |
Clinical history (%): | |||
Smoking | 312 (53.06) | 313 (53.23) | 0.003 |
Hypertension | 343 (58.33) | 345 (58.67) | 0.006 |
Diabetes mellitus | 226 (38.44) | 204 (34.69) | −0.077 |
Coronary artery disease | 128 (21.77) | 124 (21.09) | −0.016 |
Cerebrovascular disease | 24 (4.08) | 24 (4.08) | 0.000 |
Chronic kidney disease | 78 (13.27) | 80 (13.61) | 0.009 |
Hyperlipidemia | 32 (5.44) | 52 (8.84) | 0.132 |
Presentation features: | |||
Killip class | |||
Level 2–Level 4 | 106 (18.03) | 107 (18.20) | 0.004 |
Systolic BP (SBP) | 135.9 ± 40.60 | 135.4 ± 32.68 | −0.012 |
Diastolic BP (DBP) | 84.80 ± 27.74 | 84.91 ± 22.46 | 0.004 |
Heart rate, bpm | 84.65 ± 27.51 | 84.71 ± 22.98 | 0.002 |
Peak troponin I, ng/mL | 4.74 ± 11.15 | 4.33 ± 10.27 | −0.038 |
GFR | 61.64 ± 32.38 | 62.54 ± 29.13 | 0.029 |
Creatinine | 2.07 ± 2.67 | 1.94 ± 4.77 | −0.033 |
LVEF | 50.86 ± 12.22 | 50.74 ± 11.06 | −0.009 |
Angiographic findings: | |||
Left main disease * | 27 (4.59) | 42 (7.14) | 0.108 |
No. of disease vessels * | 0.117 | ||
1 | 277 (47.11) | 273 (46.43) | |
2 | 177 (30.10) | 175 (29.76) | |
3 | 89 (15.14) | 108 (18.37) | |
No. of disease vessels * | 0.086 | ||
<3 | 499 (84.86) | 480 (81.63) | |
≥3 | 89 (15.14) | 108 (18.37) | |
Type: | 0.044 | ||
STEMI | 268 (45.58) | 255 (43.37) | |
NSTEMI | 320 (54.42) | 333 (56.63) |
Drug | Univariate | Multivariate | ||
---|---|---|---|---|
OR (95% CI) | p-Value | OR (95% CI) | p-Value | |
Clopidogrel | Reference | - | Reference | - |
Ticagrelor | 0.46 (0.27–0.80) | 0.005 | 0.42 (0.21–0.85) | 0.016 |
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Huang, P.-Y.; Shih, H.-M.; Huang, S.-W.; Pan, Y.-C.; Huang, F.-W.; Chen, W.-K.; Yu, S.-H. Comparison of In-Hospital Major Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction Treated with Ticagrelor or Clopidogrel in the Emergency Department: A Propensity Score Matched Retrospective Cohort Study. Healthcare 2023, 11, 2246. https://doi.org/10.3390/healthcare11162246
Huang P-Y, Shih H-M, Huang S-W, Pan Y-C, Huang F-W, Chen W-K, Yu S-H. Comparison of In-Hospital Major Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction Treated with Ticagrelor or Clopidogrel in the Emergency Department: A Propensity Score Matched Retrospective Cohort Study. Healthcare. 2023; 11(16):2246. https://doi.org/10.3390/healthcare11162246
Chicago/Turabian StyleHuang, Po-Yao, Hong-Mo Shih, Szu-Wei Huang, Yan-Cheng Pan, Fen-Wei Huang, Wei-Kung Chen, and Shao-Hua Yu. 2023. "Comparison of In-Hospital Major Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction Treated with Ticagrelor or Clopidogrel in the Emergency Department: A Propensity Score Matched Retrospective Cohort Study" Healthcare 11, no. 16: 2246. https://doi.org/10.3390/healthcare11162246
APA StyleHuang, P.-Y., Shih, H.-M., Huang, S.-W., Pan, Y.-C., Huang, F.-W., Chen, W.-K., & Yu, S.-H. (2023). Comparison of In-Hospital Major Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction Treated with Ticagrelor or Clopidogrel in the Emergency Department: A Propensity Score Matched Retrospective Cohort Study. Healthcare, 11(16), 2246. https://doi.org/10.3390/healthcare11162246