Events that happened in our study were few
Events that happened in our study were few. of death, recurrent myocardial infarctions, re-intervention, and major bleeding. We studied 321 patients (54 female patients, 16.82%). The mean age of the patients was 56.65??11.01?years. Ticagrelor was stopped in 76.7% on follow-up. It was stopped in 6.3%, 13.5%, 13.1%, 21.9%, and 45.1% of patients during the first month but after discharge, between first and third months, between 3 and 6?months, between 6 and 12?months, and after 12?months, respectively. In the majority of patients, ticagrelor was replaced by clopidogrel (97.9%). It was stopped according to the physicians discretion in 79.3% of patients, whereas it was the cost of the drug that made the patient to get swapped to another agent in 18.6%. No difference in the primary composite outcome was observed between the groups where ticagrelor was continued post 12? months and ticagrelor was continued and ticagrelor was switched-over to another agent. Similarly, no difference in death, recurrent myocardial infarctions, re-interventions, or major bleeding manifestations was observed between the two groups. Conclusion In patients with acute coronary syndrome who undergo PCI, we observed that early discontinuation of ticagrelor and switching over to other P2Y12 inhibitors after discharge did not affect clinical outcomes. test. Categorical variables were analyzed by chi-squared test. A value 0.05 was considered significant. SPSS v20 (IBM) was used for statistical analysis. Results We identified 336 patients. Out of this, we studied 321 patients (54 female patients, 16.8%) after the exclusion of 15 patients who could not be reached. The mean age of the patients was 56.65??11.01?years (Table?1). The median duration of follow-up was 22?months (interquartile range 18). History of diabetes and hypertension were present in 56.7% and 52.3%, respectively. Prior history of CAD was present in 43.9%. Most of the patients had STEMI (47.4%) while 39.9% had unstable angina, and 12.8% had NSTEMI. The majority of the patients had good LV systolic function with an ejection fraction of >?55% in 57.9%. Mild LV dysfunction (LVEF45C55%), moderate LV dysfunction (30C45%), and severe LV dysfunction (30%) were present in 19.9%, 18.7%, and 3.4%, respectively. Nearly one third of the patients (35.2%) were taking aspirin before the index procedure. Some of the patients were receiving Epiberberine other antiplatelet agents that included 26.8% of patients with clopidogrel, 2.2% of patients with prasugrel, and 9.3% of patients with ticagrelor. More than 40% of individuals were using a statin. The history of prior bleeding was noted in 0.9%. The majority of the patients had left anterior descending artery (LAD) territory involvement. Most patients (98.8%) received stents, while 1.2% received plain old balloon angioplasty. Only two patients had received bare-metal stents. The mean stent used per patient was 1.3. Most of the patients had received Gp2b/3a inhibitor (82.9%). Non-culprit vessel intervention was done in 25.5% of patients during the index procedure or the same admission. Table 1 Baseline characteristic of patient populations. %valuevaluevalue
Diabetes741.213044.50.79Acute coronary syndrome groupUSA741.211840.40.99NSTEMI211.83512.0STEMI847.113947.6Ejection fractionEF??30%00.082.70.8EF??55%1164.7517058.2EF-30C45%317.65518.8EF-45C55%317.65920.2Culprit vesselLeft anterior descending artery (LAD)741.216054.80.32Circumflex (LCX)211.854916.8Right coronary artery (RCA)847.17826.7Left main or triple vessel disease00.051.7Reason for stopping0.70Ticagrelor – not stooped635.66722.9Ticagrelor stopped – physician-based decision15.9114.7Ticagrelor stopped – cost1058.817861.0Ticagrelor stopped – non-availability of drug00.031.0Ticagrelor stopped – side effects00.010.3Nature of drug that was used during switch-over from ticagrelorTicagrelor continued635.36722.90.45Clopidogrel1164.721975.0Prasugrel00.062.1Timing of ticagrelor stopped and eventNot stopped635.36622.6Stopped 1?month211.8134.50.44Stopped 1C3?months15.93110.6Stopped 3C6?months211.8299.9Stopped 6C12?months317.64916.8Stopped >?12?months317.610435.6 Open in a separate window Discussion In this real-world single-center experience study, we observed early discontinuation of ticagrelor after discharge, and switching-over to other P2Y12 agents in patients with acute coronary syndrome did not affect clinical outcomes. It was found that ticagrelor was stopped early, i.e., before the end of the first year in the majority of Epiberberine patients. It happened more frequently after 6?months post Epiberberine PCI. Though the cost of ticagrelor remained an important factor in the discontinuation of the drug, it was stopped at the discretion of the physician in the majority of patients. Newer oral P2Y12 receptor blockers like ticagrelor and prasugrel have been shown to have increased bleeding risk as compared to clopidogrel [2, 3]. Similar to the PLATO trial, a large prospective registry from Sweden has shown better outcomes with ticagrelor as compared to clopidogrel . Though few case reports from India attributed increased risk of bleeding to newer Epiberberine antiplatelet agents like ticagrelor , large observational studies have documented the safety of ticagrelor and prasugrel in the Indian subset of patients [6C8]. Similar to the other two studies from India, we observed ticagrelor to be safe in Indian patients. Major societal guidelines recommend continuing ticagrelor at least 12?months post-acute coronary syndrome interventions [9C11] Igf1 based on the PLATO trial. In contrary to the above findings, the CHANGE-DAPT study has shown that ticagrelor was associated with increased events.