Efficacy and Safety of Switching from Clopidogrelto Ticagrelor at the Time of Discharge in STEMIPatients Treated with a Pharmacoinvasive Approach

Abstract

Objective: The aim of the study was to search for the efficacy and safety of switching from clopidogrel to ticagrelorat the time of discharge in ST-segment elevation myocardial infarction (STEMI) patients treated with a pharmacoin vasive approach. Materials and Methods: STEMI patients who were managed with pharmacoinvasive approach were involved in the studypopulation. Patients were divided into two groups as clopidogrel and ticagrelor depending on the choice of P2Y12 inhibitorat the time of discharge. All-cause mortality, stent thrombosis, recurrent myocardial infarction, need for target lesion revas cularization, and any major bleeding (BARC classification ≥2) were defined as composite clinical end points at the end of the12th month follow-up. Results: A total of 194 patients (male: 156 patients, 80.4%; mean age 60.2±11.5 years) were involved in the study popu lation (130 clopidogrel and 64 ticagrelor patients). The median time interval for switching time to ticagrelor was 48 (48–72)h. In a subgroup analysis for patients with a stented segment ≥30 mm, discharge with clopidogrel was related to 6.9 timesincrease in composite end points compared to patients discharged with ticagrelor (odds ratio: 6.955, confidence interval95%: 1.512–30.980, p=0.012). Conclusion: Switching from clopidogrel to ticagrelor at the 48th h following fibrinolytic administration had similar safetyend points in STEMI patients managed with pharmacoinvasive approach. In a subgroup of study patients with a total stentlength of ≥30 mm, switching to ticagrelor was found to be superior to clopidogrel regarding composite clinical end points.