Efficacy and safety of ticagrelor versus clopidogrel in acute myocardial infarction-associated cardiogenic shock: a propensity score-matched analysis

Efficacy and safety of ticagrelor versus clopidogrel in acute myocardial infarction-associated cardiogenic shock: apropensity score-matched analysishttps://doi.org/10.1093/eurheartj/ehaf784.2070 AbstractBackgroundCardiogenic shock secondary to acute myocardial infarction (AMICS) is a critical condition with significant hemostatic challenges. Despite the widespread use of P2Y12 inhibitors, current evidence comes primarily from stable populations. This study aimed to compare the efficacy and safety of ticagrelor versus clopidogrel in a propensity-matched cohort of acute myocardial infarction patients. MethodsWe conducted a single-center retrospective study to evaluate the impact of ticagrelor versus clopidogrel in acutemyocardial infarction patients receiving dual antiplatelet therapy (DAPT), hospitalized between 2016 and 2024. Propensity score matching was performed on a cohort of 151 patients (103 on clopidogrel; 48 on ticagrelor) using a 1:1matching protocol without replacement (matching tolerance 20%). Matching variables included age, sex, chronic kidney disease (CKD), peak troponin levels (pTn), occurrence of cardiac arrest, and initial SCAI shock classification. Theprimary endpoint was 30-day all-cause mortality. Secondary endpoints included major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial reinfarction, stroke or transient ischemicattack, and embolic events, as well as major bleeding events, defined as BARC ≥3. ResultsA total of 88 patients were included, 44 within each group, with a mean age of 60.5 ± 11 years, 71.6% male, 44.3%presenting in SCAI-C, and 47.7% on mechanical circulatory support (MCS), including IABP, VA-ECMO, and/or Impella. At 30-day follow-up, 39 patients (44.3%) had died. Baseline characteristics were well balanced between groups,including age (p=0.138), sex (p=0.813) and SCAI shock classification (p=0.910)–Table 1. Although not statistically significant, other antithrombotic therapies showed numerical variations between groups. Anticoagulation was morecommon in clopidogrel-treated patients (70.5% vs. 56.8%), whereas Gp IIb/IIIa antagonists were more frequent in those receiving ticagrelor (20.5% vs. 11.4%). Ticagrelor was associated with a significantly lower 30-day mortality rate (34.1% vs. 54.6%; Log-rank p=0.018) -Figure 1, and reduced major adverse cardiovascular events incidence (34.1% vs 56.8%; Log-rank p=0.018) -Figure 2. In the subgroup with MCS the magnitude of benefit was similar (OR 0.419 [95% CI=0.159-1.101]; p=0.078), despite not reaching statistical significance. No significant differences were observed between groups regarding the incidence of major bleeding events (63.6% vs.59.1%; OR 1.212 [95% CI=0.513 - 2.861]; p=0.662). ConclusionsIn this propensity score-matched analysis of acutemyocardial infarction patients receiving dual antiplatelet therapy, ticagrelor was associated with significantly lower 30-day mortality and major adverse cardiovascular events rates compared to clopidogrel, without a correspondingincrease in major bleeding risk. These findings may suggest a potential benefit of ticagrelor in this high-risk population; however, further prospective studies are needed.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.