SPC365

Efficacy and Safety of Ticagrelor Versus Clopidogrel in Acute Myocardial Infarction-Associated Cardiogenic Shock: A Propensity Score-Matched Analysis

Session: SESSÃO DE POSTERS 37 - DOENÇAS CARDIOVASCULARES - TERAPÊUTICA ANTITROMBÓTICA
Speaker: Márcia Presume

Congress: CPC 2025
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type: Cartazes
FP Number: ---
Authors: Márcia Presume; Samuel Azevedo; João Presume; Ana Rita Bello; C. Santos-Jorge; Rui Miguel Gomes; André Moniz Garcia; Catarina Brízido; Christopher Strong; António Tralhão; Manuel Almeida; Jorge Ferreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">Background: </span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">Cardiogenic 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 AMICS patients.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">Methods: </span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">We conducted a single-center retrospective study to evaluate the impact of ticagrelor versus clopidogrel in AMICS 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 1:1 matching 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. The primary 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 ischemic attack, and embolic events, as well as major bleeding events, defined as BARC &ge;3.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">Results: </span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">A total of&nbsp; 88 patients were included, 44 within each group, with a mean age of 60.5 &plusmn; 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)&ndash;<strong><em>Table 1</em></strong>. Although not statistically significant, other antithrombotic therapies showed numerical variations between groups. Anticoagulation was more common 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%).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">Ticagrelor was associated with a significantly lower 30-day mortality rate (34.1% vs. 54.6%; Log-rank p=0.018) -<strong><em>Figure 1</em></strong>, and reduced MACE incidence (34.1% vs 56.8%; Log-rank p=0.018) -<strong><em>Figure 2</em></strong>. In the subgroup with MCS the magnitude of benefit was similar (OR 0.419 [95% CI=0.159-1.101]; p=0.078), despite</span></span><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"> not reaching statistical significance.</span> <span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">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).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">Conclusions: </span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">In this propensity score-matched analysis of AMICS patients receiving DAPT, ticagrelor was associated with significantly lower 30-day mortality and MACE rates compared to clopidogrel, without a corresponding increase in major bleeding risk. These findings may suggest a potential benefit of ticagrelor in this high-risk population; however, further prospective studies are needed.</span></span></span></span></span></p>