Thrombosis Journal (Apr 2025)

Clopidogrel vs. ticagrelor in ST-elevation myocardial infarction complicated by cardiogenic shock undergoing primary PCI

  • Can Zhou,
  • Minghui Zhang,
  • Zixu Zhao,
  • Enze Li,
  • Yichen Zhao,
  • Wei Luo,
  • Keyang Zheng,
  • Yu Liu,
  • Chengqian Yin,
  • Xinyong Zhang,
  • Hai Gao,
  • Dong Zhao,
  • Changsheng Ma

DOI
https://doi.org/10.1186/s12959-025-00721-z
Journal volume & issue
Vol. 23, no. 1
pp. 1 – 10

Abstract

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Abstract Background Although ticagrelor is recommended as opposed to clopidogrel in antiplatelet strategy for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI), evidence is limited in patients with cardiogenic shock (CS). Objective This study aims to evaluate the comparative efficacy and safety profile of ticagrelor and clopidogrel in patients with STEMI-CS undergoing pPCI. Methods Using data from a nationwide, multicenter registry, eligible patients were stratified into clopidogrel or ticagrelor based on the choice of P2Y12 inhibitors within 24 h of first medical contact. Multivariable-adjusted Cox regression analyses, along with Cox models adjusted for propensity score matching and inverse probability treatment weighting were conducted to compare outcomes between ticagrelor and clopidogrel. The efficacy and safety outcomes were in-hospital all-cause mortality and major bleeding. Results Among 729 STEMI-CS patients in our cohort, 403 received clopidogrel and 326 received ticagrelor. Multivariable-adjusted Cox regression analyses showed that ticagrelor was not associated with a significant difference in all-cause mortality (adjusted HR: 1.04; 95% CI: 0.69–1.56; p = 0.840) and major bleeding (adjusted HR: 1.30; 95% CI: 0.62–2.76; p = 0.489) compared to clopidogrel. Consistent results were found in the analyses adjusted by propensity score matching and inverse probability of treatment weighting. Conclusions Our findings suggest that the choice of either ticagrelor or clopidogrel was feasible as a P2Y12 inhibitor for dual anti-platelet strategy in STEMI-CS patients undergoing pPCI, as no significant difference between these two agents was observed in all-cause mortality and major bleeding during hospitalization. Trial registration ClinicalTrials.gov, NCT02306616. Registered 29 November 2014.

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