The Canadian journal of cardiology · 2025
Potent P2Y12 Inhibitors vs Clopidogrel in Cancer Patients Undergoing Percutaneous Coronary Intervention.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Gitto Mauro, Sartori Samantha, Vogel Birgit, Leone Pier Pasquale, Smith Kenneth, Bay Benjamin, Krishnan Prakash, Sweeny Joseph, Oliva Angelo, Moreno Pedro, Gilhooley Sean, Di Muro Francesca Maria, Krishnamoorthy Parasuram Melarcode, Kini Annapoorna, Dangas George, Mehran Roxana, Sharma Samin
Аннотация
BACKGROUND: Patients with cancer undergoing percutaneous coronary intervention (PCI) experience a higher risk of both ischemic and bleeding events. The aim of this study was to assess ischemic and bleeding risks after PCI in cancer patients treated with potent P2Y12 inhibitors (P2Y12i; prasugrel and ticagrelor) compared with clopidogrel.
METHODS: Consecutive patients with cancer undergoing PCI at a tertiary center between 2012 and 2022 and discharged on P2Y12i were included in this study. Propensity score covariate adjustment was used to account for baseline differences between patients treated with potent P2Y12i and clopidogrel. Key clinical endpoints included major adverse cardiac and cerebrovascular events (MACCEs---composite of death, myocardial infarction, or stroke) and major bleeding.
RESULTS: Of the 1702 included patients, 373 (21.9%) were treated with potent P2Y12i and 1329 (78.1%) with clopidogrel. Factors associated with potent P2Y12i use were acute coronary syndrome presentation and lesion length, whereas clopidogrel use was associated with active cancer status, thrombocytopenia, older age, and femoral access. MACCEs at 1 year occurred in 3.5% of patients treated with potent P2Y12i vs 6.8% of those receiving clopidogrel (log-rank test, P = 0.035; adjusted hazard ratio [adj HR] 0.53, 95% confidence interval [CI] 0.26-1.10), but no differences in bleeding risk were detected (5.5% vs 7.0%, adj HR 0.92, 95% CI 0.53-1.60). The reduction in MACCEs was significant in patients with remission but not active cancer (Pinteraction = 0.011).
CONCLUSIONS: Among cancer patients undergoing PCI, potent P2Y12i use was associated with similar bleeding risk and lower incidence of ischemic events compared with clopidogrel, but with no significant difference after propensity score adjustment.
METHODS: Consecutive patients with cancer undergoing PCI at a tertiary center between 2012 and 2022 and discharged on P2Y12i were included in this study. Propensity score covariate adjustment was used to account for baseline differences between patients treated with potent P2Y12i and clopidogrel. Key clinical endpoints included major adverse cardiac and cerebrovascular events (MACCEs---composite of death, myocardial infarction, or stroke) and major bleeding.
RESULTS: Of the 1702 included patients, 373 (21.9%) were treated with potent P2Y12i and 1329 (78.1%) with clopidogrel. Factors associated with potent P2Y12i use were acute coronary syndrome presentation and lesion length, whereas clopidogrel use was associated with active cancer status, thrombocytopenia, older age, and femoral access. MACCEs at 1 year occurred in 3.5% of patients treated with potent P2Y12i vs 6.8% of those receiving clopidogrel (log-rank test, P = 0.035; adjusted hazard ratio [adj HR] 0.53, 95% confidence interval [CI] 0.26-1.10), but no differences in bleeding risk were detected (5.5% vs 7.0%, adj HR 0.92, 95% CI 0.53-1.60). The reduction in MACCEs was significant in patients with remission but not active cancer (Pinteraction = 0.011).
CONCLUSIONS: Among cancer patients undergoing PCI, potent P2Y12i use was associated with similar bleeding risk and lower incidence of ischemic events compared with clopidogrel, but with no significant difference after propensity score adjustment.