P2Y12 Inhibitor Selection and Ischemic Outcomes in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Real-World Registry Analysis

Abstract

This study evaluated whether ticagrelor use is associated with improved ischemic outcomes compared with clopidogrel in Korean patients with acute coronary syndrome undergoing percutaneous coronary intervention. We analyzed patient-level data from 1,199 patients (614 clopidogrel, 585 ticagrelor) enrolled in two prospective registries. Stabilized inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics between the two groups. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, stroke, or any revascularization. After IPTW adjustment, the weighted incidence of MACE was 8.1% in the clopidogrel group and 5.0% in the ticagrelor group, but this difference did not reach statistical significance (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.33-1.14; p=0.120). Target vessel failure also showed no significant differences between the groups (HR, 0.54; p=0.177). All-cause death was nominally lower in the ticagrelor group (3.4% vs. 1.1%; HR, 0.33; p=0.025); however, this was not accompanied by a reduction in other ischemic endpoints. Subgroup analyses revealed no significant treatment-by-subgroup interactions across various ischemic- or bleeding-risk features. In conclusion, ticagrelor did not demonstrate a statistically significant reduction in ischemic events compared with clopidogrel in this real-world Korean registry. These findings support the importance of individualized P2Y12 inhibitor selection based on patient-specific risk profiles.