Analysis Of Switching From Ticagrelor To Clopidogrel In Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention

Objective:To investigate the frequency,impact of switching from ticagrelor to clopidogrel in acute coronary syndrome patients undergoing percutaneous coronary intervention(PCI).Methods:The present study was a single-center,prospective cohort study.This study included 307 ACS patients under the treatment of ticagrelor after PCI from December 2017 to February 2019.Clinical follow-up was performed through telephone or out-patient visit.The occurrences,reasons of switching from ticagrelor to clopidogrel were recorded.Patients were divided into the de-escalation group defined as a change from ticagrelor to clopidogrel and the standard therapy group without ticagrelor cessation in the follow-up period.The primary outcome was major adverse cardiac events(cardiovascular death,non-fatal myocardial infarction,coronary revascularization and ischemic stroke)and the secondary outcome was unexpected rehospitalization for angina.Bleeding events were described by the Bleeding Academic Research Consortium(BARC)≥type 3.Results: 1.A total of 602 participants completed the study.After 12-month follow up,the rate of switching from ticagrelor to clopidogrel was 19.18%(56/292).The elderly patients(≥75),proportion of male patients,and unstable angina in the de-escalation group were significantly higher than in the standard group(all P<0.05).The other baseline characteristics of two groups were no significant difference(P>0.05).2.The incidence of de-escalation within 3-month was 57.14%(32/56).The median time of switching was 80 days(interquartile range,24–173).Reasons for ticagrelor deescalation included bleeding(26.8%),ticagrelor-related dyspnea(12.5%)and costs(30.4%).3.Multivariate logistic regression analysis showed that female sex(OR=2.024,95%CI:1.016～4.032,P=0.046)was independent risk factor for de-escalation from ticagrelor to clopidogrel.4.There were no differences on the primary outcome,including cardiac death,myocardial infarction,revascularization or stroke,at 1 year between the de-escalation group and standard therapy group(8.9%vs5.5%,HR=1.62,95%CI:0.58～4.56,P=0.36).The rate of the unexpected rehospitalization for angina was no significant differences(5.36%vs5.93%,P>0.05).Conclusions: In routine clinical practice,switching from ticagrelor to clopidogrel in patients with acute coronary syndrome undergoing percutaneous coronary intervention occurred in 19.18% patients.The most frequent causes were adverse effects(bleeding and dyspnea),followed by costs.De-escalation may not have impact on the incidence of MACE and the secondary outcome.