In-hospital outcomes of ticagrelor versus clopidogrel in patients 75 years or older with acute coronary syndrome: findings from the Improving Care for Cardiovascular Disease in China (CCC)-Acute Coronary Syndrome Project

Na Yang; Jing Liu; Jun Liu; Yongchen Hao; Jr Sidney C. Smith; Yong Huo; Gregg C. Fonarow; Junbo Ge; Louise Morgan; Changsheng Ma; Yaling Han; Dong Zhao; Aihua Li; Bao Li; Biao Xu; Bin Li; Bin Liu; Bin Wang; Yuanjun He; Bo Yu; Baisong Yang; Caidong Luo; Changqian Wang; Changyong Liu; Chuanliang Liang; Chuanyu Gao; Chunlin Lai; Chuntong Wang; Chunyan Zhang; Chunyang Wu; Congliang Zhang; Bin Cui; Lan Huang; Daoquan Peng; Dawen Xu; Di Wu; Dongmei Zhu; Dongsheng Chai; Dongyan Li; Fakuan Tang; Jun Xiao; Fang Zhao; Fangfang Huang; Fanju Meng; Fengwei Li; Fudong Gan; Gang Xu; Gengsheng Sang; Genshan Ma; Guixia Zhang; Guizhou Tao; Guo Li; Guoduo Chen; Guoqin Xin; Guoqing Li; Guosheng Fu; Guoxiong Chen; Hailong Lin; Haiping Guo; Haiyun Lin; Hong Jiang; Hong Liu; Hong Luan; Hong Zhang; Honghua Deng; Hongwei Li; Hongju Wang; Hualing Liu; Hui Dong; Hui Liu; Huifang Zhang; Huifeng Wang; Huimin Chu; Jiabin Xi; Jian Yang; Jianfeng Ye; Jianhao Li; Jianhong Tao; Jianwen Liu; Jiao Mei Yang; Jiawang Ding; Jiayi Tong; Jie Chen; Jie Jiang; Jie Yang; Jifu Li; Jinchuan Yan; Jing Hu; Jing Xu; Jingfeng Wang; Jinglan Diao; Jingshan Zhao; Jinru Wei; Jinxing Yi; Jinzi Su; Jiong Tang; Jiyan Chen; Jiyan Yin; Juexin Fan; Jun Guan; Junbo Ge; Junming Liu; Junping Deng; Junping Fang; Junxia Li; Kaihong Chen; Kalan Luo; Keng Wu; Lang Hong; Lang Li; Li Jiang; Li Wei; Lijun Meng; Likun Ma; Lilong Tang; Lin Wang; Lin Wei; Ling Li; Ling Tao; Liqiong Yang; Wei Li; Man Zhang; Kaiming Chen; Meisheng Lai; Miao Tian; Mingcheng Bai; Minghua Han; Moshui Chen; Naiyi Liang; Nan Jia; Han Bing; Peng Qu; Pengfei Zhang; Ping Chen; Ping Hou; Ping Xie; Ping Zhang; Pingshuan Dong; Qiang Wu; Qiang Xie; Qiaoqing Zhong; Qichun Wang; Qinfeng Su; Rong Chang; Rong Lin; Ruiping Zhao; Shaobin Jia; Shaoping Nie; Shaowu Ye; Shenghu He; Shengyong Chen; Shixin Ma; Shuangbin Li; Shuanli Xin; Shudong Xia; Shuhua Zhang; Shuqiu Qu; Shuren Ma; Siding Wang; Songbai Li; Suxin Luo; Tao Liu; Tao Zhang; Tian Tuo; Tianchang Li; Tianlun Yang; Tianmin Du; Tongguo Wu; Wei Liu; Wei Mao; Wei Tuo; Wei Wang; Weihong Jiang; Weijian Huang; Weijun Liu; Weiqing Fan; Weiting Xu; Wenhua Lin; Xi Su; Xia Chen; Xianan Zhang; Xianghua Fu; Xiangjun Yang; Xianxian Zhao; Xiaochuan Ma; Xiaofei Sun; Xiaojun Wang; Xiaolan Li; Xiaolei Li; Xiaoli Yang; Xiaoping Chen; Xiaoqin Zhang; Xiaoshu Cheng; Xiaowei Peng; Xiaowen Ma; Xiaoyong Qi; Xiaoyun Feng; Ximing Chen; Xin Tang; Shengxing Tang; Xingsheng Zhao; Xiufeng Chen; Xudong Li; Xue Li; Xuebo Liu; Xuemei Peng; Yaling Han; Yan Wang; Yanbo Niu; Yang Yu; Yang Zheng; Yanli Wang; Yanlie Zheng; Yansong Guo; Yanzong Yang; Yi Huang; Yin Liu; Ying Guo; Yingchao Luo; Yinglu Hao; Yingxian Sun; Yingzhong Lin; Yitong Ma; Yong Guo; Yong Li; Yongdong Li; Yonglin Zhang; Yuanzhe Jin; Yue Li; Yuehua Huang; Yuemin Sun; Yuheng Yang; Yuhua Zhu; Yuhuan Shi; Yulan Zhao; Yuqing Hou; Zeqi Zheng; Zesheng Xu; Zewei Ouyang; Zeyuan He; Zhan Lv; Zhanquan Li; Zhaofa He; Zheng Ji; Zheng Zhang; Zhenguo Ji; Zhenqi Su; Zhenyu Yang; Zhihong Ou; Zhijian Yang; Zhiming Yang; Zhirong Wang; Zhiyuan Song; Zhongshan Wang; Zuyi Yuan

doi:10.1093/ageing/afac231

In-hospital outcomes of ticagrelor versus clopidogrel in patients 75 years or older with acute coronary syndrome: findings from the Improving Care for Cardiovascular Disease in China (CCC)-Acute Coronary Syndrome Project

Na Yang, Jing Liu, Jun Liu, Yongchen Hao, Jr Sidney C. Smith, Yong Huo, Gregg C. Fonarow, Junbo Ge, Louise Morgan, Changsheng Ma, Yaling Han, Dong Zhao, Aihua Li, Bao Li, Biao Xu, Bin Li, Bin Liu, Bin Wang, Yuanjun He, Bo YuBaisong Yang, Caidong Luo, Changqian Wang, Changyong Liu, Chuanliang Liang, Chuanyu Gao, Chunlin Lai, Chuntong Wang, Chunyan Zhang, Chunyang Wu, Congliang Zhang, Bin Cui, Lan Huang, Daoquan Peng, Dawen Xu, Di Wu, Dongmei Zhu, Dongsheng Chai, Dongyan Li, Fakuan Tang, Jun Xiao, Fang Zhao, Fangfang Huang, Fanju Meng, Fengwei Li, Fudong Gan, Gang Xu, Gengsheng Sang, Genshan Ma, Guixia Zhang, Guizhou Tao, Guo Li, Guoduo Chen, Guoqin Xin, Guoqing Li, Guosheng Fu, Guoxiong Chen, Hailong Lin, Haiping Guo, Haiyun Lin, Hong Jiang, Hong Liu, Hong Luan, Hong Zhang, Honghua Deng, Hongwei Li, Hongju Wang, Hualing Liu, Hui Dong, Hui Liu, Huifang Zhang, Huifeng Wang, Huimin Chu, Jiabin Xi, Jian Yang, Jianfeng Ye, Jianhao Li, Jianhong Tao, Jianwen Liu, Jiao Mei Yang, Jiawang Ding, Jiayi Tong, Jie Chen, Jie Jiang, Jie Yang, Jifu Li, Jinchuan Yan, Jing Hu, Jing Xu, Jingfeng Wang, Jinglan Diao, Jingshan Zhao, Jinru Wei, Jinxing Yi, Jinzi Su, Jiong Tang, Jiyan Chen, Jiyan Yin, Juexin Fan, Jun Guan, Junbo Ge, Junming Liu, Junping Deng, Junping Fang, Junxia Li, Kaihong Chen, Kalan Luo, Keng Wu, Lang Hong, Lang Li, Li Jiang, Li Wei, Lijun Meng, Likun Ma, Lilong Tang, Lin Wang, Lin Wei, Ling Li, Ling Tao, Liqiong Yang, Wei Li, Man Zhang, Kaiming Chen, Meisheng Lai, Miao Tian, Mingcheng Bai, Minghua Han, Moshui Chen, Naiyi Liang, Nan Jia, Han Bing, Peng Qu, Pengfei Zhang, Ping Chen, Ping Hou, Ping Xie, Ping Zhang, Pingshuan Dong, Qiang Wu, Qiang Xie, Qiaoqing Zhong, Qichun Wang, Qinfeng Su, Rong Chang, Rong Lin, Ruiping Zhao, Shaobin Jia, Shaoping Nie, Shaowu Ye, Shenghu He, Shengyong Chen, Shixin Ma, Shuangbin Li, Shuanli Xin, Shudong Xia, Shuhua Zhang, Shuqiu Qu, Shuren Ma, Siding Wang, Songbai Li, Suxin Luo, Tao Liu, Tao Zhang, Tian Tuo, Tianchang Li, Tianlun Yang, Tianmin Du, Tongguo Wu, Wei Liu, Wei Mao, Wei Tuo, Wei Wang, Weihong Jiang, Weijian Huang, Weijun Liu, Weiqing Fan, Weiting Xu, Wenhua Lin, Xi Su, Xia Chen, Xianan Zhang, Xianghua Fu, Xiangjun Yang, Xianxian Zhao, Xiaochuan Ma, Xiaofei Sun, Xiaojun Wang, Xiaolan Li, Xiaolei Li, Xiaoli Yang, Xiaoping Chen, Xiaoqin Zhang, Xiaoshu Cheng, Xiaowei Peng, Xiaowen Ma, Xiaoyong Qi, Xiaoyun Feng, Ximing Chen, Xin Tang, Shengxing Tang, Xingsheng Zhao, Xiufeng Chen, Xudong Li, Xue Li, Xuebo Liu, Xuemei Peng, Yaling Han, Yan Wang, Yanbo Niu, Yang Yu, Yang Zheng, Yanli Wang, Yanlie Zheng, Yansong Guo, Yanzong Yang, Yi Huang, Yin Liu, Ying Guo, Yingchao Luo, Yinglu Hao, Yingxian Sun, Yingzhong Lin, Yitong Ma, Yong Guo, Yong Li, Yongdong Li, Yonglin Zhang, Yuanzhe Jin, Yue Li, Yuehua Huang, Yuemin Sun, Yuheng Yang, Yuhua Zhu, Yuhuan Shi, Yulan Zhao, Yuqing Hou, Zeqi Zheng, Zesheng Xu, Zewei Ouyang, Zeyuan He, Zhan Lv, Zhanquan Li, Zhaofa He, Zheng Ji, Zheng Zhang, Zhenguo Ji, Zhenqi Su, Zhenyu Yang, Zhihong Ou, Zhijian Yang, Zhiming Yang, Zhirong Wang, Zhiyuan Song, Zhongshan Wang, Zuyi Yuan

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: The evidence for the comparative effectiveness and safety of ticagrelor versus clopidogrel in older patients with acute coronary syndrome (ACS) is limited, especially in the acute phase of ACS. This study aimed to compare the in-hospital outcomes of ticagrelor versus clopidogrel in older patients with ACS. Methods: Hospitalised ACS patients aged ≥75 years who were recruited to the Improving Care for Cardiovascular Disease in China-ACS project between November 2014 and December 2019 and received aspirin and P2Y12 receptor inhibitors within 24 h after first medical contact were included. The primary outcomes were in-hospital major adverse cardiovascular events (MACE) and major bleeding. Multivariable Cox regression was performed to evaluate the comparative effectiveness and safety of ticagrelor and clopidogrel. Inverse probability of treatment weighting (IPTW) and propensity score matching analyses were performed to evaluate the robustness of the results. Results: Of 18,244 ACS patients, 18.5% received ticagrelor. Multivariable-adjusted analysis revealed comparable risks of in-hospital MACE between patients receiving ticagrelor and clopidogrel (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.92-1.35). However, ticagrelor use was associated with 45% higher risk of in-hospital major bleeding compared with clopidogrel use (HR 1.45, 95% CI 1.09-1.91). Similar results were found in the IPTW analysis. Conclusions: ACS patients aged ≥75 years receiving ticagrelor during the acute phase had similar risk of in-hospital MACE, but higher risk of in-hospital major bleeding compared with those receiving clopidogrel. More evidence is needed to guide the use of P2Y12 receptor inhibitors during hospitalisation in older patients with ACS. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02306616.

Original language	English
Article number	afac231
Journal	Age and Ageing
Volume	51
Issue number	11
DOIs	https://doi.org/10.1093/ageing/afac231
State	Published - 1 Nov 2022
Externally published	Yes

Keywords

acute coronary syndrome
antiplatelet therapy
in-hospital bleeding
in-hospital major adverse cardiovascular events
older people

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10.1093/ageing/afac231

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Yang, N., Liu, J., Liu, J., Hao, Y., Smith, J. S. C., Huo, Y., Fonarow, G. C., Ge, J., Morgan, L., Ma, C., Han, Y., Zhao, D., Li, A., Li, B., Xu, B., Li, B., Liu, B., Wang, B., He, Y., ... Yuan, Z. (2022). In-hospital outcomes of ticagrelor versus clopidogrel in patients 75 years or older with acute coronary syndrome: findings from the Improving Care for Cardiovascular Disease in China (CCC)-Acute Coronary Syndrome Project. Age and Ageing, 51(11), Article afac231. https://doi.org/10.1093/ageing/afac231

@article{1d029303ae6c4e5ba5c381c8654d4a07,

title = "In-hospital outcomes of ticagrelor versus clopidogrel in patients 75 years or older with acute coronary syndrome: findings from the Improving Care for Cardiovascular Disease in China (CCC)-Acute Coronary Syndrome Project",

abstract = "Background: The evidence for the comparative effectiveness and safety of ticagrelor versus clopidogrel in older patients with acute coronary syndrome (ACS) is limited, especially in the acute phase of ACS. This study aimed to compare the in-hospital outcomes of ticagrelor versus clopidogrel in older patients with ACS. Methods: Hospitalised ACS patients aged ≥75 years who were recruited to the Improving Care for Cardiovascular Disease in China-ACS project between November 2014 and December 2019 and received aspirin and P2Y12 receptor inhibitors within 24 h after first medical contact were included. The primary outcomes were in-hospital major adverse cardiovascular events (MACE) and major bleeding. Multivariable Cox regression was performed to evaluate the comparative effectiveness and safety of ticagrelor and clopidogrel. Inverse probability of treatment weighting (IPTW) and propensity score matching analyses were performed to evaluate the robustness of the results. Results: Of 18,244 ACS patients, 18.5% received ticagrelor. Multivariable-adjusted analysis revealed comparable risks of in-hospital MACE between patients receiving ticagrelor and clopidogrel (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.92-1.35). However, ticagrelor use was associated with 45% higher risk of in-hospital major bleeding compared with clopidogrel use (HR 1.45, 95% CI 1.09-1.91). Similar results were found in the IPTW analysis. Conclusions: ACS patients aged ≥75 years receiving ticagrelor during the acute phase had similar risk of in-hospital MACE, but higher risk of in-hospital major bleeding compared with those receiving clopidogrel. More evidence is needed to guide the use of P2Y12 receptor inhibitors during hospitalisation in older patients with ACS. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02306616.",

keywords = "acute coronary syndrome, antiplatelet therapy, in-hospital bleeding, in-hospital major adverse cardiovascular events, older people",

author = "Na Yang and Jing Liu and Jun Liu and Yongchen Hao and Smith, {Jr Sidney C.} and Yong Huo and Fonarow, {Gregg C.} and Junbo Ge and Louise Morgan and Changsheng Ma and Yaling Han and Dong Zhao and Aihua Li and Bao Li and Biao Xu and Bin Li and Bin Liu and Bin Wang and Yuanjun He and Bo Yu and Baisong Yang and Caidong Luo and Changqian Wang and Changyong Liu and Chuanliang Liang and Chuanyu Gao and Chunlin Lai and Chuntong Wang and Chunyan Zhang and Chunyang Wu and Congliang Zhang and Bin Cui and Lan Huang and Daoquan Peng and Dawen Xu and Di Wu and Dongmei Zhu and Dongsheng Chai and Dongyan Li and Fakuan Tang and Jun Xiao and Fang Zhao and Fangfang Huang and Fanju Meng and Fengwei Li and Fudong Gan and Gang Xu and Gengsheng Sang and Genshan Ma and Guixia Zhang and Guizhou Tao and Guo Li and Guoduo Chen and Guoqin Xin and Guoqing Li and Guosheng Fu and Guoxiong Chen and Hailong Lin and Haiping Guo and Haiyun Lin and Hong Jiang and Hong Liu and Hong Luan and Hong Zhang and Honghua Deng and Hongwei Li and Hongju Wang and Hualing Liu and Hui Dong and Hui Liu and Huifang Zhang and Huifeng Wang and Huimin Chu and Jiabin Xi and Jian Yang and Jianfeng Ye and Jianhao Li and Jianhong Tao and Jianwen Liu and Yang, {Jiao Mei} and Jiawang Ding and Jiayi Tong and Jie Chen and Jie Jiang and Jie Yang and Jifu Li and Jinchuan Yan and Jing Hu and Jing Xu and Jingfeng Wang and Jinglan Diao and Jingshan Zhao and Jinru Wei and Jinxing Yi and Jinzi Su and Jiong Tang and Jiyan Chen and Jiyan Yin and Juexin Fan and Jun Guan and Junbo Ge and Junming Liu and Junping Deng and Junping Fang and Junxia Li and Kaihong Chen and Kalan Luo and Keng Wu and Lang Hong and Lang Li and Li Jiang and Li Wei and Lijun Meng and Likun Ma and Lilong Tang and Lin Wang and Lin Wei and Ling Li and Ling Tao and Liqiong Yang and Wei Li and Man Zhang and Kaiming Chen and Meisheng Lai and Miao Tian and Mingcheng Bai and Minghua Han and Moshui Chen and Naiyi Liang and Nan Jia and Han Bing and Peng Qu and Pengfei Zhang and Ping Chen and Ping Hou and Ping Xie and Ping Zhang and Pingshuan Dong and Qiang Wu and Qiang Xie and Qiaoqing Zhong and Qichun Wang and Qinfeng Su and Rong Chang and Rong Lin and Ruiping Zhao and Shaobin Jia and Shaoping Nie and Shaowu Ye and Shenghu He and Shengyong Chen and Shixin Ma and Shuangbin Li and Shuanli Xin and Shudong Xia and Shuhua Zhang and Shuqiu Qu and Shuren Ma and Siding Wang and Songbai Li and Suxin Luo and Tao Liu and Tao Zhang and Tian Tuo and Tianchang Li and Tianlun Yang and Tianmin Du and Tongguo Wu and Wei Liu and Wei Mao and Wei Tuo and Wei Wang and Weihong Jiang and Weijian Huang and Weijun Liu and Weiqing Fan and Weiting Xu and Wenhua Lin and Xi Su and Xia Chen and Xianan Zhang and Xianghua Fu and Xiangjun Yang and Xianxian Zhao and Xiaochuan Ma and Xiaofei Sun and Xiaojun Wang and Xiaolan Li and Xiaolei Li and Xiaoli Yang and Xiaoping Chen and Xiaoqin Zhang and Xiaoshu Cheng and Xiaowei Peng and Xiaowen Ma and Xiaoyong Qi and Xiaoyun Feng and Ximing Chen and Xin Tang and Shengxing Tang and Xingsheng Zhao and Xiufeng Chen and Xudong Li and Xue Li and Xuebo Liu and Xuemei Peng and Yaling Han and Yan Wang and Yanbo Niu and Yang Yu and Yang Zheng and Yanli Wang and Yanlie Zheng and Yansong Guo and Yanzong Yang and Yi Huang and Yin Liu and Ying Guo and Yingchao Luo and Yinglu Hao and Yingxian Sun and Yingzhong Lin and Yitong Ma and Yong Guo and Yong Li and Yongdong Li and Yonglin Zhang and Yuanzhe Jin and Yue Li and Yuehua Huang and Yuemin Sun and Yuheng Yang and Yuhua Zhu and Yuhuan Shi and Yulan Zhao and Yuqing Hou and Zeqi Zheng and Zesheng Xu and Zewei Ouyang and Zeyuan He and Zhan Lv and Zhanquan Li and Zhaofa He and Zheng Ji and Zheng Zhang and Zhenguo Ji and Zhenqi Su and Zhenyu Yang and Zhihong Ou and Zhijian Yang and Zhiming Yang and Zhirong Wang and Zhiyuan Song and Zhongshan Wang and Zuyi Yuan",

year = "2022",

month = nov,

day = "1",

doi = "10.1093/ageing/afac231",

language = "English",

volume = "51",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

number = "11",

}

Yang, N, Liu, J, Liu, J, Hao, Y, Smith, JSC, Huo, Y, Fonarow, GC, Ge, J, Morgan, L, Ma, C, Han, Y, Zhao, D, Li, A, Li, B, Xu, B, Li, B, Liu, B, Wang, B, He, Y, Yu, B, Yang, B, Luo, C, Wang, C, Liu, C, Liang, C, Gao, C, Lai, C, Wang, C, Zhang, C, Wu, C, Zhang, C, Cui, B, Huang, L, Peng, D, Xu, D, Wu, D, Zhu, D, Chai, D, Li, D, Tang, F, Xiao, J, Zhao, F, Huang, F, Meng, F, Li, F, Gan, F, Xu, G, Sang, G, Ma, G, Zhang, G, Tao, G, Li, G, Chen, G, Xin, G, Li, G, Fu, G, Chen, G, Lin, H, Guo, H, Lin, H, Jiang, H, Liu, H, Luan, H, Zhang, H, Deng, H, Li, H, Wang, H, Liu, H, Dong, H, Liu, H, Zhang, H, Wang, H, Chu, H, Xi, J, Yang, J, Ye, J, Li, J, Tao, J, Liu, J, Yang, JM, Ding, J, Tong, J, Chen, J, Jiang, J, Yang, J, Li, J, Yan, J, Hu, J, Xu, J, Wang, J, Diao, J, Zhao, J, Wei, J, Yi, J, Su, J, Tang, J, Chen, J, Yin, J, Fan, J, Guan, J, Ge, J, Liu, J, Deng, J, Fang, J, Li, J, Chen, K, Luo, K, Wu, K, Hong, L, Li, L, Jiang, L, Wei, L, Meng, L, Ma, L, Tang, L, Wang, L, Wei, L, Li, L, Tao, L, Yang, L, Li, W, Zhang, M, Chen, K, Lai, M, Tian, M, Bai, M, Han, M, Chen, M, Liang, N, Jia, N, Bing, H, Qu, P, Zhang, P, Chen, P, Hou, P, Xie, P, Zhang, P, Dong, P, Wu, Q, Xie, Q, Zhong, Q, Wang, Q, Su, Q, Chang, R, Lin, R, Zhao, R, Jia, S, Nie, S, Ye, S, He, S, Chen, S, Ma, S, Li, S, Xin, S, Xia, S, Zhang, S, Qu, S, Ma, S, Wang, S, Li, S, Luo, S, Liu, T, Zhang, T, Tuo, T, Li, T, Yang, T, Du, T, Wu, T, Liu, W, Mao, W, Tuo, W, Wang, W, Jiang, W, Huang, W, Liu, W, Fan, W, Xu, W, Lin, W, Su, X, Chen, X, Zhang, X, Fu, X, Yang, X, Zhao, X, Ma, X, Sun, X, Wang, X, Li, X, Li, X, Yang, X, Chen, X, Zhang, X, Cheng, X, Peng, X, Ma, X, Qi, X, Feng, X, Chen, X, Tang, X, Tang, S, Zhao, X, Chen, X, Li, X, Li, X, Liu, X, Peng, X, Han, Y, Wang, Y, Niu, Y, Yu, Y, Zheng, Y, Wang, Y, Zheng, Y, Guo, Y, Yang, Y, Huang, Y, Liu, Y, Guo, Y, Luo, Y, Hao, Y, Sun, Y, Lin, Y, Ma, Y, Guo, Y, Li, Y, Li, Y, Zhang, Y, Jin, Y, Li, Y, Huang, Y, Sun, Y, Yang, Y, Zhu, Y, Shi, Y, Zhao, Y, Hou, Y, Zheng, Z, Xu, Z, Ouyang, Z, He, Z, Lv, Z, Li, Z, He, Z, Ji, Z, Zhang, Z, Ji, Z, Su, Z, Yang, Z, Ou, Z, Yang, Z, Yang, Z, Wang, Z, Song, Z, Wang, Z & Yuan, Z 2022, 'In-hospital outcomes of ticagrelor versus clopidogrel in patients 75 years or older with acute coronary syndrome: findings from the Improving Care for Cardiovascular Disease in China (CCC)-Acute Coronary Syndrome Project', Age and Ageing, vol. 51, no. 11, afac231. https://doi.org/10.1093/ageing/afac231

In-hospital outcomes of ticagrelor versus clopidogrel in patients 75 years or older with acute coronary syndrome: findings from the Improving Care for Cardiovascular Disease in China (CCC)-Acute Coronary Syndrome Project. / Yang, Na; Liu, Jing; Liu, Jun et al.
In: Age and Ageing, Vol. 51, No. 11, afac231, 01.11.2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - In-hospital outcomes of ticagrelor versus clopidogrel in patients 75 years or older with acute coronary syndrome

T2 - findings from the Improving Care for Cardiovascular Disease in China (CCC)-Acute Coronary Syndrome Project

AU - Yang, Na

AU - Liu, Jing

AU - Liu, Jun

AU - Hao, Yongchen

AU - Smith, Jr Sidney C.

AU - Huo, Yong

AU - Fonarow, Gregg C.

AU - Ge, Junbo

AU - Morgan, Louise

AU - Ma, Changsheng

AU - Han, Yaling

AU - Zhao, Dong

AU - Li, Aihua

AU - Li, Bao

AU - Xu, Biao

AU - Li, Bin

AU - Liu, Bin

AU - Wang, Bin

AU - He, Yuanjun

AU - Yu, Bo

AU - Yang, Baisong

AU - Luo, Caidong

AU - Wang, Changqian

AU - Liu, Changyong

AU - Liang, Chuanliang

AU - Gao, Chuanyu

AU - Lai, Chunlin

AU - Wang, Chuntong

AU - Zhang, Chunyan

AU - Wu, Chunyang

AU - Zhang, Congliang

AU - Cui, Bin

AU - Huang, Lan

AU - Peng, Daoquan

AU - Xu, Dawen

AU - Wu, Di

AU - Zhu, Dongmei

AU - Chai, Dongsheng

AU - Li, Dongyan

AU - Tang, Fakuan

AU - Xiao, Jun

AU - Zhao, Fang

AU - Huang, Fangfang

AU - Meng, Fanju

AU - Li, Fengwei

AU - Gan, Fudong

AU - Xu, Gang

AU - Sang, Gengsheng

AU - Ma, Genshan

AU - Zhang, Guixia

AU - Tao, Guizhou

AU - Li, Guo

AU - Chen, Guoduo

AU - Xin, Guoqin

AU - Li, Guoqing

AU - Fu, Guosheng

AU - Chen, Guoxiong

AU - Lin, Hailong

AU - Guo, Haiping

AU - Lin, Haiyun

AU - Jiang, Hong

AU - Liu, Hong

AU - Luan, Hong

AU - Zhang, Hong

AU - Deng, Honghua

AU - Li, Hongwei

AU - Wang, Hongju

AU - Liu, Hualing

AU - Dong, Hui

AU - Liu, Hui

AU - Zhang, Huifang

AU - Wang, Huifeng

AU - Chu, Huimin

AU - Xi, Jiabin

AU - Yang, Jian

AU - Ye, Jianfeng

AU - Li, Jianhao

AU - Tao, Jianhong

AU - Liu, Jianwen

AU - Yang, Jiao Mei

AU - Ding, Jiawang

AU - Tong, Jiayi

AU - Chen, Jie

AU - Jiang, Jie

AU - Yang, Jie

AU - Li, Jifu

AU - Yan, Jinchuan

AU - Hu, Jing

AU - Xu, Jing

AU - Wang, Jingfeng

AU - Diao, Jinglan

AU - Zhao, Jingshan

AU - Wei, Jinru

AU - Yi, Jinxing

AU - Su, Jinzi

AU - Tang, Jiong

AU - Chen, Jiyan

AU - Yin, Jiyan

AU - Fan, Juexin

AU - Guan, Jun

AU - Ge, Junbo

AU - Liu, Junming

AU - Deng, Junping

AU - Fang, Junping

AU - Li, Junxia

AU - Chen, Kaihong

AU - Luo, Kalan

AU - Wu, Keng

AU - Hong, Lang

AU - Li, Lang

AU - Jiang, Li

AU - Wei, Li

AU - Meng, Lijun

AU - Ma, Likun

AU - Tang, Lilong

AU - Wang, Lin

AU - Wei, Lin

AU - Li, Ling

AU - Tao, Ling

AU - Yang, Liqiong

AU - Li, Wei

AU - Zhang, Man

AU - Chen, Kaiming

AU - Lai, Meisheng

AU - Tian, Miao

AU - Bai, Mingcheng

AU - Han, Minghua

AU - Chen, Moshui

AU - Liang, Naiyi

AU - Jia, Nan

AU - Bing, Han

AU - Qu, Peng

AU - Zhang, Pengfei

AU - Chen, Ping

AU - Hou, Ping

AU - Xie, Ping

AU - Zhang, Ping

AU - Dong, Pingshuan

AU - Wu, Qiang

AU - Xie, Qiang

AU - Zhong, Qiaoqing

AU - Wang, Qichun

AU - Su, Qinfeng

AU - Chang, Rong

AU - Lin, Rong

AU - Zhao, Ruiping

AU - Jia, Shaobin

AU - Nie, Shaoping

AU - Ye, Shaowu

AU - He, Shenghu

AU - Chen, Shengyong

AU - Ma, Shixin

AU - Li, Shuangbin

AU - Xin, Shuanli

AU - Xia, Shudong

AU - Zhang, Shuhua

AU - Qu, Shuqiu

AU - Ma, Shuren

AU - Wang, Siding

AU - Li, Songbai

AU - Luo, Suxin

AU - Liu, Tao

AU - Zhang, Tao

AU - Tuo, Tian

AU - Li, Tianchang

AU - Yang, Tianlun

AU - Du, Tianmin

AU - Wu, Tongguo

AU - Liu, Wei

AU - Mao, Wei

AU - Tuo, Wei

AU - Wang, Wei

AU - Jiang, Weihong

AU - Huang, Weijian

AU - Liu, Weijun

AU - Fan, Weiqing

AU - Xu, Weiting

AU - Lin, Wenhua

AU - Su, Xi

AU - Chen, Xia

AU - Zhang, Xianan

AU - Fu, Xianghua

AU - Yang, Xiangjun

AU - Zhao, Xianxian

AU - Ma, Xiaochuan

AU - Sun, Xiaofei

AU - Wang, Xiaojun

AU - Li, Xiaolan

AU - Li, Xiaolei

AU - Yang, Xiaoli

AU - Chen, Xiaoping

AU - Zhang, Xiaoqin

AU - Cheng, Xiaoshu

AU - Peng, Xiaowei

AU - Ma, Xiaowen

AU - Qi, Xiaoyong

AU - Feng, Xiaoyun

AU - Chen, Ximing

AU - Tang, Xin

AU - Tang, Shengxing

AU - Zhao, Xingsheng

AU - Chen, Xiufeng

AU - Li, Xudong

AU - Li, Xue

AU - Liu, Xuebo

AU - Peng, Xuemei

AU - Han, Yaling

AU - Wang, Yan

AU - Niu, Yanbo

AU - Yu, Yang

AU - Zheng, Yang

AU - Wang, Yanli

AU - Zheng, Yanlie

AU - Guo, Yansong

AU - Yang, Yanzong

AU - Huang, Yi

AU - Liu, Yin

AU - Guo, Ying

AU - Luo, Yingchao

AU - Hao, Yinglu

AU - Sun, Yingxian

AU - Lin, Yingzhong

AU - Ma, Yitong

AU - Guo, Yong

AU - Li, Yong

AU - Li, Yongdong

AU - Zhang, Yonglin

AU - Jin, Yuanzhe

AU - Li, Yue

AU - Huang, Yuehua

AU - Sun, Yuemin

AU - Yang, Yuheng

AU - Zhu, Yuhua

AU - Shi, Yuhuan

AU - Zhao, Yulan

AU - Hou, Yuqing

AU - Zheng, Zeqi

AU - Xu, Zesheng

AU - Ouyang, Zewei

AU - He, Zeyuan

AU - Lv, Zhan

AU - Li, Zhanquan

AU - He, Zhaofa

AU - Ji, Zheng

AU - Zhang, Zheng

AU - Ji, Zhenguo

AU - Su, Zhenqi

AU - Yang, Zhenyu

AU - Ou, Zhihong

AU - Yang, Zhijian

AU - Yang, Zhiming

AU - Wang, Zhirong

AU - Song, Zhiyuan

AU - Wang, Zhongshan

AU - Yuan, Zuyi

PY - 2022/11/1

Y1 - 2022/11/1

N2 - Background: The evidence for the comparative effectiveness and safety of ticagrelor versus clopidogrel in older patients with acute coronary syndrome (ACS) is limited, especially in the acute phase of ACS. This study aimed to compare the in-hospital outcomes of ticagrelor versus clopidogrel in older patients with ACS. Methods: Hospitalised ACS patients aged ≥75 years who were recruited to the Improving Care for Cardiovascular Disease in China-ACS project between November 2014 and December 2019 and received aspirin and P2Y12 receptor inhibitors within 24 h after first medical contact were included. The primary outcomes were in-hospital major adverse cardiovascular events (MACE) and major bleeding. Multivariable Cox regression was performed to evaluate the comparative effectiveness and safety of ticagrelor and clopidogrel. Inverse probability of treatment weighting (IPTW) and propensity score matching analyses were performed to evaluate the robustness of the results. Results: Of 18,244 ACS patients, 18.5% received ticagrelor. Multivariable-adjusted analysis revealed comparable risks of in-hospital MACE between patients receiving ticagrelor and clopidogrel (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.92-1.35). However, ticagrelor use was associated with 45% higher risk of in-hospital major bleeding compared with clopidogrel use (HR 1.45, 95% CI 1.09-1.91). Similar results were found in the IPTW analysis. Conclusions: ACS patients aged ≥75 years receiving ticagrelor during the acute phase had similar risk of in-hospital MACE, but higher risk of in-hospital major bleeding compared with those receiving clopidogrel. More evidence is needed to guide the use of P2Y12 receptor inhibitors during hospitalisation in older patients with ACS. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02306616.

AB - Background: The evidence for the comparative effectiveness and safety of ticagrelor versus clopidogrel in older patients with acute coronary syndrome (ACS) is limited, especially in the acute phase of ACS. This study aimed to compare the in-hospital outcomes of ticagrelor versus clopidogrel in older patients with ACS. Methods: Hospitalised ACS patients aged ≥75 years who were recruited to the Improving Care for Cardiovascular Disease in China-ACS project between November 2014 and December 2019 and received aspirin and P2Y12 receptor inhibitors within 24 h after first medical contact were included. The primary outcomes were in-hospital major adverse cardiovascular events (MACE) and major bleeding. Multivariable Cox regression was performed to evaluate the comparative effectiveness and safety of ticagrelor and clopidogrel. Inverse probability of treatment weighting (IPTW) and propensity score matching analyses were performed to evaluate the robustness of the results. Results: Of 18,244 ACS patients, 18.5% received ticagrelor. Multivariable-adjusted analysis revealed comparable risks of in-hospital MACE between patients receiving ticagrelor and clopidogrel (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.92-1.35). However, ticagrelor use was associated with 45% higher risk of in-hospital major bleeding compared with clopidogrel use (HR 1.45, 95% CI 1.09-1.91). Similar results were found in the IPTW analysis. Conclusions: ACS patients aged ≥75 years receiving ticagrelor during the acute phase had similar risk of in-hospital MACE, but higher risk of in-hospital major bleeding compared with those receiving clopidogrel. More evidence is needed to guide the use of P2Y12 receptor inhibitors during hospitalisation in older patients with ACS. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02306616.

KW - acute coronary syndrome

KW - antiplatelet therapy

KW - in-hospital bleeding

KW - in-hospital major adverse cardiovascular events

KW - older people

UR - http://www.scopus.com/inward/record.url?scp=85142918582&partnerID=8YFLogxK

U2 - 10.1093/ageing/afac231

DO - 10.1093/ageing/afac231

M3 - Article

C2 - 36413586

AN - SCOPUS:85142918582

SN - 0002-0729

VL - 51

JO - Age and Ageing

JF - Age and Ageing

IS - 11

M1 - afac231

ER -