Aspirin Combined With Ticagrelor or Clopidogrel in STEMI Patients With Diabetes Mellitus and Poor Glycemic Control Undergoing Primary PCI: A Multicenter Retrospective Cohort Study.

BACKGROUND

The safety and efficacy of aspirin combined with ticagrelor or clopidogrel remain unclear in ST-segment elevation myocardial infarction (STEMI) patients with Diabetes mellitus (DM) and poor glycemic control.

AIMS: This study aims to assess the efficacy and safety of ticagrelor versus clopidogrel-based dual antiplatelet therapy in STEMI patients with DM and poor glycemic control undergoing pPCI.

METHODS

We evaluated 2732 STEMI patients with DM and poor glycemic control who underwent primary percutaneous coronary intervention (pPCI) and were registered in the "Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS)" program between November 2014 and December 2019. Using propensity score matching (PSM) and cox proportional hazards regression, we compared the in-hospital risk of major adverse cardiovascular events (MACCE), TIMI bleeding events, and net adverse clinical events (NACE) between patients receiving aspirin combined with either ticagrelor or clopidogrel.

RESULTS

After PSM, the risk of in-hospital MACCE (HR = 0.545, 95% CI: 0.321-0.926, p = 0.025), Cardiac death (HR = 0.380, 95% CI: 0.149-0.971, p = 0.043) and NACE (HR = 0.728, 95% CI: 0.560-0.947, p = 0.018) was significantly lower in the ticagrelor group compared with the clopidogrel group (p < 0.05), while no significant difference was observed in the incidence of TIMI-bleeding events between the two groups (p > 0.05).

CONCLUSION

Among STEMI patients with DM and poor glycemic control undergoing pPCI, ticagrelor use was associated with a low rate of MACCE, without an excessive risk of bleeding.

TRIAL REGISTRATION: The information of clinical trial registration for CCC-ACS project can be found at http://clinicaltrials.gov/study/NCT02306616.