Safety and efficacy of ticagrelor versus clopidogrel in the treatment of CYP2C19 allele-deficient acute coronary syndrome with diabetes mellitus
Objective To compare the safety and efficacy of ticagrelor and clopidogrel in the treatment of CYP2C19 allele-deficient a-cute coronary syndrome(ACS)complicated with diabetes mellitus(DM).Methods A total of 750 patients with ACS and DM with CYP2C19 allele loss admitted to the Department of Cardiology of General Hospital of Northern Theater Command from March 2016 to March 2017 were selected as the study objects.Patients were divided into clopidogrel group(n=439)and ticagrelor group(n=311)ac-cording to the type of P2Y12 inhibitor used.Baseline data,surgical data,discharge medication,and endpoint events within 12 months were recorded and compared between the two groups.Kaplan-Meier survival analysis was used to plot the risk curve of the end event.Results Before propensity score matching,age,hypertension and previous stroke rates in ticagrelor group were lower than those in clo-pidogrel group,and the proportions of male,left main branch,left anterior descending branch and creatinine clearance were higher than those in clopidogrel group,with statistical significance(P<0.05),and there was statistical significance in smoking status between the two groups(P<0.05),and there was no significant difference in baseline data between ticagrelor group and clopidogrel group(P>0.05).After matching the propensity score,the incidence of ischemic events,all-cause death and stroke in ticagrelor group was lower than that in clopidogrel group,and the incidence of bleeding academic research consortium(BARC)type 3-5 hemorrhage was higher than that in clopidogrel group,with statistical significance(P<0.05).Kaplan-Meier survival curve showed that after matching the propensity score,the incidence of ischemic events in ticagrelor group was lower than that in clopidogrel group,and the incidence of BARC type 3-5 bleeding events was higher than that in clopidogrel group,with statistical significance(P<0.05).Conclusion Com-pared with clopidogrel,the incidence of ischemic events is reduced and the incidence of bleeding events is increased in patients with ACS and DM who are treated with CYP2C19 allele loss using ticagrelor.
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