Age- and Sex-Specific Disparities in Outcomes After Ticagrelor Versus Clopidogrel in East Asian Patients
It is unknown whether there are age- and gender-related differences in the safety and efficacy of potent P2Y12 inhibitors in East Asian populations with a different bleeding or ischemic propensity. Using data from the TICAKOREA (Ticagrelor Versus Clopidogrel in Asian/Korean Patients with ACS Intende...
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| Veröffentlicht in: | The American journal of cardiology 2023-11, Vol.207, p.237-244 |
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| creator | Jang, Mi Hee Kim, Ah-Ram Kim, Taesun Oh, Hyeon Jeong Lee, Jeen Hwa Lee, Yeon Jeong Kim, Sehee Lee, Junghoon Kim, Ju Hyeon Cha, Sung Joo Kim, Tae Oh Kang, Do-Yoon Lee, Pil Hyung Ahn, Jung-Min Park, Duk-Woo Park, Seung-Jung |
| description | It is unknown whether there are age- and gender-related differences in the safety and efficacy of potent P2Y12 inhibitors in East Asian populations with a different bleeding or ischemic propensity. Using data from the TICAKOREA (Ticagrelor Versus Clopidogrel in Asian/Korean Patients with ACS Intended for Invasive Management) trial comparing ticagrelor versus clopidogrel for 800 Korean patients with acute coronary syndrome, the safety and efficacy outcomes were compared according to age ( |
| doi_str_mv | 10.1016/j.amjcard.2023.08.124 |
| format | Article |
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Using data from the TICAKOREA (Ticagrelor Versus Clopidogrel in Asian/Korean Patients with ACS Intended for Invasive Management) trial comparing ticagrelor versus clopidogrel for 800 Korean patients with acute coronary syndrome, the safety and efficacy outcomes were compared according to age (<75 vs ≥75 years) and gender (men vs women). The primary bleeding end point was clinically significant bleeding, and the primary ischemic end point was a major adverse cardiovascular event (MACE) at 12 months. The incidences of clinically significant bleeding were significantly higher after ticagrelor than after clopidogrel in patients aged <75 years (adjusted hazard ratio [HR] 2.56, 95% confidence interval [CI] 1.40 to 4.67) but not in patients aged ≥75 years (adjusted HR 1.1, 95% CI 0.40 to 3.38). The incidences of MACEs were significantly higher after ticagrelor than after clopidogrel in patients aged ≥75 years (adjusted HR 6.14, 95% CI 1.40 to 26.90) but not in patients aged <75 years (adjusted HR 0.93, 95% CI 0.50 to 1.73). The incidences of clinically significant bleeding were significantly higher after ticagrelor than after clopidogrel in men (adjusted HR 2.69, 95% CI 1.38 to 5.24) but not in women (adjusted HR 1.49, 95% CI 0.64 to 3.46). The adjusted risks of MACEs after ticagrelor or clopidogrel were not significantly different between men and women. In conclusion, there were substantial age- and gender-related differences in bleeding and ischemic outcomes after ticagrelor or clopidogrel in Korean patients with acute coronary syndrome. Clinical Trial Registration: URL: https://www.clinicaltrials.gov Unique identifier: NCT02094963.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2023.08.124</identifier><identifier>PMID: 37757520</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Coronary Syndrome - drug therapy ; Acute coronary syndromes ; Age ; Aged ; antiplatelets ; Bleeding ; bleeding events ; Clopidogrel ; Clopidogrel - therapeutic use ; East Asian People ; Effectiveness ; Female ; Gender ; Hemorrhage - chemically induced ; Hemorrhage - epidemiology ; Humans ; Ischemia ; ischemic events ; Male ; Men ; Patients ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors - therapeutic use ; Purinergic P2Y Receptor Antagonists - therapeutic use ; Safety ; Sex differences ; Stroke ; Thrombosis ; Ticagrelor - therapeutic use ; Treatment Outcome ; Women</subject><ispartof>The American journal of cardiology, 2023-11, Vol.207, p.237-244</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>2023. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-99eecf41df1558ff5977b4a76388bdb89416b52a4c720486f84c389708d0ddf53</citedby><cites>FETCH-LOGICAL-c393t-99eecf41df1558ff5977b4a76388bdb89416b52a4c720486f84c389708d0ddf53</cites><orcidid>0000-0001-6643-0239</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2885557626?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,778,782,3539,27911,27912,45982,64370,64372,64374,72224</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37757520$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jang, Mi Hee</creatorcontrib><creatorcontrib>Kim, Ah-Ram</creatorcontrib><creatorcontrib>Kim, Taesun</creatorcontrib><creatorcontrib>Oh, Hyeon Jeong</creatorcontrib><creatorcontrib>Lee, Jeen Hwa</creatorcontrib><creatorcontrib>Lee, Yeon Jeong</creatorcontrib><creatorcontrib>Kim, Sehee</creatorcontrib><creatorcontrib>Lee, Junghoon</creatorcontrib><creatorcontrib>Kim, Ju Hyeon</creatorcontrib><creatorcontrib>Cha, Sung Joo</creatorcontrib><creatorcontrib>Kim, Tae Oh</creatorcontrib><creatorcontrib>Kang, Do-Yoon</creatorcontrib><creatorcontrib>Lee, Pil Hyung</creatorcontrib><creatorcontrib>Ahn, Jung-Min</creatorcontrib><creatorcontrib>Park, Duk-Woo</creatorcontrib><creatorcontrib>Park, Seung-Jung</creatorcontrib><creatorcontrib>TICAKOREA Investigators</creatorcontrib><title>Age- and Sex-Specific Disparities in Outcomes After Ticagrelor Versus Clopidogrel in East Asian Patients</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>It is unknown whether there are age- and gender-related differences in the safety and efficacy of potent P2Y12 inhibitors in East Asian populations with a different bleeding or ischemic propensity. Using data from the TICAKOREA (Ticagrelor Versus Clopidogrel in Asian/Korean Patients with ACS Intended for Invasive Management) trial comparing ticagrelor versus clopidogrel for 800 Korean patients with acute coronary syndrome, the safety and efficacy outcomes were compared according to age (<75 vs ≥75 years) and gender (men vs women). The primary bleeding end point was clinically significant bleeding, and the primary ischemic end point was a major adverse cardiovascular event (MACE) at 12 months. The incidences of clinically significant bleeding were significantly higher after ticagrelor than after clopidogrel in patients aged <75 years (adjusted hazard ratio [HR] 2.56, 95% confidence interval [CI] 1.40 to 4.67) but not in patients aged ≥75 years (adjusted HR 1.1, 95% CI 0.40 to 3.38). The incidences of MACEs were significantly higher after ticagrelor than after clopidogrel in patients aged ≥75 years (adjusted HR 6.14, 95% CI 1.40 to 26.90) but not in patients aged <75 years (adjusted HR 0.93, 95% CI 0.50 to 1.73). The incidences of clinically significant bleeding were significantly higher after ticagrelor than after clopidogrel in men (adjusted HR 2.69, 95% CI 1.38 to 5.24) but not in women (adjusted HR 1.49, 95% CI 0.64 to 3.46). The adjusted risks of MACEs after ticagrelor or clopidogrel were not significantly different between men and women. In conclusion, there were substantial age- and gender-related differences in bleeding and ischemic outcomes after ticagrelor or clopidogrel in Korean patients with acute coronary syndrome. Clinical Trial Registration: URL: https://www.clinicaltrials.gov Unique identifier: NCT02094963.</description><subject>Acute Coronary Syndrome - drug therapy</subject><subject>Acute coronary syndromes</subject><subject>Age</subject><subject>Aged</subject><subject>antiplatelets</subject><subject>Bleeding</subject><subject>bleeding events</subject><subject>Clopidogrel</subject><subject>Clopidogrel - therapeutic use</subject><subject>East Asian People</subject><subject>Effectiveness</subject><subject>Female</subject><subject>Gender</subject><subject>Hemorrhage - chemically induced</subject><subject>Hemorrhage - epidemiology</subject><subject>Humans</subject><subject>Ischemia</subject><subject>ischemic events</subject><subject>Male</subject><subject>Men</subject><subject>Patients</subject><subject>Percutaneous Coronary Intervention</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Purinergic P2Y Receptor Antagonists - therapeutic use</subject><subject>Safety</subject><subject>Sex differences</subject><subject>Stroke</subject><subject>Thrombosis</subject><subject>Ticagrelor - therapeutic use</subject><subject>Treatment Outcome</subject><subject>Women</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkUtv1DAUhS0EokPhJ4AssWGTYCd2bK_QaFoeUqUitbC1HPu6OEriYCcI_j0ezcCCDSs_9J1zr85B6CUlNSW0ezvUZhqsSa5uSNPWRNa0YY_QjkqhKqpo-xjtCCFNpShTF-hZzkN5Usq7p-iiFYIL3pAd-rZ_gAqb2eE7-FndLWCDDxZfhbyYFNYAGYcZ326rjVO57_0KCd8Hax4SjDHhr5DylvFhjEtw8fh55K9NXvE-BzPjz6aYzGt-jp54M2Z4cT4v0Zf31_eHj9XN7YdPh_1NZVvVrpVSANYz6jzlXHrPlRA9M6JrpexdLxWjXc8bw6xoCJOdl8y2UgkiHXHO8_YSvTn5Lil-3yCvegrZwjiaGeKWdSMFoUyQThT09T_oELc0l-0KJTnnomu6QvETZVPMOYHXSwqTSb80JfpYhR70uQp9rEITqUsVRffq7L71E7i_qj_ZF-DdCYASx48ASWdborLgQgK7ahfDf0b8BqDMm6w</recordid><startdate>20231115</startdate><enddate>20231115</enddate><creator>Jang, Mi Hee</creator><creator>Kim, Ah-Ram</creator><creator>Kim, Taesun</creator><creator>Oh, Hyeon Jeong</creator><creator>Lee, Jeen Hwa</creator><creator>Lee, Yeon Jeong</creator><creator>Kim, Sehee</creator><creator>Lee, Junghoon</creator><creator>Kim, Ju Hyeon</creator><creator>Cha, Sung Joo</creator><creator>Kim, Tae Oh</creator><creator>Kang, Do-Yoon</creator><creator>Lee, Pil Hyung</creator><creator>Ahn, Jung-Min</creator><creator>Park, Duk-Woo</creator><creator>Park, Seung-Jung</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6643-0239</orcidid></search><sort><creationdate>20231115</creationdate><title>Age- and Sex-Specific Disparities in Outcomes After Ticagrelor Versus Clopidogrel in East Asian Patients</title><author>Jang, Mi Hee ; Kim, Ah-Ram ; Kim, Taesun ; Oh, Hyeon Jeong ; Lee, Jeen Hwa ; Lee, Yeon Jeong ; Kim, Sehee ; Lee, Junghoon ; Kim, Ju Hyeon ; Cha, Sung Joo ; Kim, Tae Oh ; Kang, Do-Yoon ; Lee, Pil Hyung ; Ahn, Jung-Min ; Park, Duk-Woo ; Park, Seung-Jung</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-99eecf41df1558ff5977b4a76388bdb89416b52a4c720486f84c389708d0ddf53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acute Coronary Syndrome - drug therapy</topic><topic>Acute coronary syndromes</topic><topic>Age</topic><topic>Aged</topic><topic>antiplatelets</topic><topic>Bleeding</topic><topic>bleeding events</topic><topic>Clopidogrel</topic><topic>Clopidogrel - therapeutic use</topic><topic>East Asian People</topic><topic>Effectiveness</topic><topic>Female</topic><topic>Gender</topic><topic>Hemorrhage - chemically induced</topic><topic>Hemorrhage - epidemiology</topic><topic>Humans</topic><topic>Ischemia</topic><topic>ischemic events</topic><topic>Male</topic><topic>Men</topic><topic>Patients</topic><topic>Percutaneous Coronary Intervention</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Purinergic P2Y Receptor Antagonists - therapeutic use</topic><topic>Safety</topic><topic>Sex differences</topic><topic>Stroke</topic><topic>Thrombosis</topic><topic>Ticagrelor - therapeutic use</topic><topic>Treatment Outcome</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jang, Mi Hee</creatorcontrib><creatorcontrib>Kim, Ah-Ram</creatorcontrib><creatorcontrib>Kim, Taesun</creatorcontrib><creatorcontrib>Oh, Hyeon Jeong</creatorcontrib><creatorcontrib>Lee, Jeen Hwa</creatorcontrib><creatorcontrib>Lee, Yeon Jeong</creatorcontrib><creatorcontrib>Kim, Sehee</creatorcontrib><creatorcontrib>Lee, Junghoon</creatorcontrib><creatorcontrib>Kim, Ju Hyeon</creatorcontrib><creatorcontrib>Cha, Sung Joo</creatorcontrib><creatorcontrib>Kim, Tae Oh</creatorcontrib><creatorcontrib>Kang, Do-Yoon</creatorcontrib><creatorcontrib>Lee, Pil Hyung</creatorcontrib><creatorcontrib>Ahn, Jung-Min</creatorcontrib><creatorcontrib>Park, Duk-Woo</creatorcontrib><creatorcontrib>Park, Seung-Jung</creatorcontrib><creatorcontrib>TICAKOREA Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jang, Mi Hee</au><au>Kim, Ah-Ram</au><au>Kim, Taesun</au><au>Oh, Hyeon Jeong</au><au>Lee, Jeen Hwa</au><au>Lee, Yeon Jeong</au><au>Kim, Sehee</au><au>Lee, Junghoon</au><au>Kim, Ju Hyeon</au><au>Cha, Sung Joo</au><au>Kim, Tae Oh</au><au>Kang, Do-Yoon</au><au>Lee, Pil Hyung</au><au>Ahn, Jung-Min</au><au>Park, Duk-Woo</au><au>Park, Seung-Jung</au><aucorp>TICAKOREA Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Age- and Sex-Specific Disparities in Outcomes After Ticagrelor Versus Clopidogrel in East Asian Patients</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2023-11-15</date><risdate>2023</risdate><volume>207</volume><spage>237</spage><epage>244</epage><pages>237-244</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>It is unknown whether there are age- and gender-related differences in the safety and efficacy of potent P2Y12 inhibitors in East Asian populations with a different bleeding or ischemic propensity. Using data from the TICAKOREA (Ticagrelor Versus Clopidogrel in Asian/Korean Patients with ACS Intended for Invasive Management) trial comparing ticagrelor versus clopidogrel for 800 Korean patients with acute coronary syndrome, the safety and efficacy outcomes were compared according to age (<75 vs ≥75 years) and gender (men vs women). The primary bleeding end point was clinically significant bleeding, and the primary ischemic end point was a major adverse cardiovascular event (MACE) at 12 months. The incidences of clinically significant bleeding were significantly higher after ticagrelor than after clopidogrel in patients aged <75 years (adjusted hazard ratio [HR] 2.56, 95% confidence interval [CI] 1.40 to 4.67) but not in patients aged ≥75 years (adjusted HR 1.1, 95% CI 0.40 to 3.38). The incidences of MACEs were significantly higher after ticagrelor than after clopidogrel in patients aged ≥75 years (adjusted HR 6.14, 95% CI 1.40 to 26.90) but not in patients aged <75 years (adjusted HR 0.93, 95% CI 0.50 to 1.73). The incidences of clinically significant bleeding were significantly higher after ticagrelor than after clopidogrel in men (adjusted HR 2.69, 95% CI 1.38 to 5.24) but not in women (adjusted HR 1.49, 95% CI 0.64 to 3.46). The adjusted risks of MACEs after ticagrelor or clopidogrel were not significantly different between men and women. In conclusion, there were substantial age- and gender-related differences in bleeding and ischemic outcomes after ticagrelor or clopidogrel in Korean patients with acute coronary syndrome. Clinical Trial Registration: URL: https://www.clinicaltrials.gov Unique identifier: NCT02094963.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37757520</pmid><doi>10.1016/j.amjcard.2023.08.124</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-6643-0239</orcidid></addata></record> |
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| ispartof | The American journal of cardiology, 2023-11, Vol.207, p.237-244 |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present); ProQuest Central UK/Ireland |
| subjects | Acute Coronary Syndrome - drug therapy Acute coronary syndromes Age Aged antiplatelets Bleeding bleeding events Clopidogrel Clopidogrel - therapeutic use East Asian People Effectiveness Female Gender Hemorrhage - chemically induced Hemorrhage - epidemiology Humans Ischemia ischemic events Male Men Patients Percutaneous Coronary Intervention Platelet Aggregation Inhibitors - therapeutic use Purinergic P2Y Receptor Antagonists - therapeutic use Safety Sex differences Stroke Thrombosis Ticagrelor - therapeutic use Treatment Outcome Women |
| title | Age- and Sex-Specific Disparities in Outcomes After Ticagrelor Versus Clopidogrel in East Asian Patients |
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