Ticagrelor cuts MACE, ups bleeding in AMI patients with multivessel disease

While ticagrelor decreases the risk of major adverse cardiovascular events (MACEs) in acute myocardial infarction (AMI) patients with multivessel disease (MVD), it also appears to come with excess bleeding risk, a recent South Korea study has found.

Of the 2,275 enrolled AMI patients with MVD, 1,438 were on clopidogrel while 837 were taking ticagrelor. The primary study endpoint was MACE, defined as nonfatal AMI, target vessel revascularization, ischaemic stroke or cardiac death. Thrombolysis in myocardial infarction (TIMI) major or minor bleeding was a secondary endpoint.

After propensity score matching and over the 2-year follow-up period, the cumulative incidence of MACE was 8.6 percent in the ticagrelor arm. This was lower than that in the clopidogrel group, corresponding to a significant reduction in risk (11.9 percent; hazard ratio [HR], 0.68, 95 percent confidence interval [CI], 0.50–0.94; p=0.018).

On the other hand, TIMI major or minor bleeding events occurred more frequently in patients treated with ticagrelor (10.8 percent vs 4.8 percent), corresponding to a significant excess in risk (HR, 2.51, 95 percent CI, 1.68–3.76; p<0.001).

Overall, the resulting net incidence of clinical events was comparable between groups (11.3 percent vs 13.6 percent; HR, 0.82, 95 percent CI, 0.60–1.11; p=0.195).

Limitations of the present study included its nonrandomized design, limited available data in the registry and the lack of long-term analysis, especially in terms of the effects of ticagrelor, the researchers said. Future studies are needed to validate the current findings.