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
Authors: Yang Na , Liu Jing , Liu Jun , Hao Yongchen , Smith Jr Sidney C , Huo Yong , Fonarow Gregg C , Ge Junbo , Morgan Louise , Ma Changsheng , Han Yaling , Zhao Dong ,   the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project investigators, Li Aihua , Li Bao , Xu Biao , Li Bin , Liu Bin , Wang Bin , He Yuanjun , Yu Bo , Yang Baisong , Luo Caidong , Wang Changqian , Liu Changyong , Liang Chuanliang , Gao Chuanyu , Lai Chunlin , Wang Chuntong , Zhang Chunyan , Wu Chunyang , Zhang Congliang , Cui Bin , Huang Lan , Peng Daoquan , Xu Dawen , Wu Di , Zhu Dongmei , Chai Dongsheng , Li Dongyan , Tang Fakuan , Xiao Jun , Zhao Fang , Huang Fangfang , Meng Fanju , Li Fengwei , Gan Fudong , Xu Gang , Sang Gengsheng , Ma Genshan , Zhang Guixia , Tao Guizhou , Li Guo , Chen Guoduo , Xin Guoqin , Li Guoqing , Fu Guosheng , Chen Guoxiong , Lin Hailong , Guo Haiping , Lin Haiyun , Jiang Hong , Liu Hong , Luan Hong , Zhang Hong , Deng Honghua , Li Hongwei , Wang Hongju , Liu Hualing , Dong Hui , Liu Hui , Zhang Huifang , Wang Huifeng , Chu Huimin , Xi Jiabin , Yang Jian , Ye Jianfeng , Li Jianhao , Tao Jianhong , Liu Jianwen , Yang JiaoMei , Ding Jiawang , Tong Jiayi , Chen Jie , Jiang Jie , Yang Jie , Li Jifu , Yan Jinchuan , Hu Jing , Xu Jing , Wang Jingfeng , Diao Jinglan , Zhao Jingshan , Wei Jinru , Yi Jinxing , Su Jinzi , Tang Jiong , Chen Jiyan , Yin Jiyan , Fan Juexin , Guan Jun , Ge Junbo , Liu Junming , Deng Junping , Fang Junping , Li Junxia , Chen Kaihong , Luo Kalan , Wu Keng , Hong Lang , Li Lang , Jiang Li , Wei Li , Meng Lijun , Ma Likun , Tang Lilong , Wang Lin , Wei Lin , Li Ling , Tao Ling , Yang Liqiong , Li Wei , Zhang Man , Chen Kaiming , Lai Meisheng , Tian Miao , Bai Mingcheng , Han Minghua , Chen Moshui , Liang Naiyi , Jia Nan , Bing Han , Qu Peng , Zhang Pengfei , Chen Ping , Hou Ping , Xie Ping , Zhang Ping , Dong Pingshuan , Wu Qiang , Xie Qiang , Zhong Qiaoqing , Wang Qichun , Su Qinfeng , Chang Rong , Lin Rong , Zhao Ruiping , Jia Shaobin , Nie Shaoping , Ye Shaowu , He Shenghu , Chen Shengyong , Ma Shixin , Li Shuangbin , Xin Shuanli , Xia Shudong , Zhang Shuhua , Qu Shuqiu , Ma Shuren , Wang Siding , Li Songbai , Luo Suxin , Liu Tao , Zhang Tao , Tuo Tian , Li Tianchang , Yang Tianlun , Du Tianmin , Wu Tongguo , Liu Wei , Mao Wei , Tuo Wei , Wang Wei , Jiang Weihong , Huang Weijian , Liu Weijun , Fan Weiqing , Xu Weiting , Lin Wenhua , Su Xi , Chen Xia , Zhang Xianan , Fu Xianghua , Yang Xiangjun , Zhao Xianxian , Ma Xiaochuan , Sun Xiaofei , Wang Xiaojun , Li Xiaolan , Li Xiaolei , Yang Xiaoli , Chen Xiaoping , Chen Xiaoping , Zhang Xiaoqin , Cheng Xiaoshu , Peng Xiaowei , Ma Xiaowen , Qi Xiaoyong , Feng Xiaoyun , Chen Ximing , Tang Xin , Tang Shengxing , Zhao Xingsheng , Chen Xiufeng , Li Xudong , Li Xue , Liu Xuebo , Peng Xuemei , Han Yaling , Wang Yan , Niu Yanbo , Yu Yang , Zheng Yang , Wang Yanli , Zheng Yanlie , Guo Yansong , Yang Yanzong , Huang Yi , Liu Yin , Guo Ying , Luo Yingchao , Hao Yinglu , Sun Yingxian , Lin Yingzhong , Ma Yitong , Guo Yong , Li Yong , Li Yongdong , Zhang Yonglin , Jin Yuanzhe , Li Yue , Huang Yuehua , Sun Yuemin , Yang Yuheng , Zhu Yuhua , Shi Yuhuan , Zhao Yulan , Hou Yuqing , Zheng Zeqi , Xu Zesheng , Ouyang Zewei , He Zeyuan , Lv Zhan , Li Zhanquan , He Zhaofa , Ji Zheng , Zhang Zheng , Ji Zhenguo , Su Zhenqi , Yang Zhenyu , Ou Zhihong , Yang Zhijian , Yang Zhiming , Wang Zhirong , Song Zhiyuan , Wang Zhongshan , Yuan Zuyi 
Published: November 2022

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.