Abstract: SA-PO0438
Ticagrelor vs. Clopidogrel Treatment in Chinese Patients with CKD After Percutaneous Coronary Intervention: Implications for East Asia
Session Information
- CKM: Clinical - Epidemiology and Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Zhou, Yi-Lun, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China
- Alemasi, Akehu, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China
Background
High-quality evidence guiding optimal antiplatelet strategies in patients with chronic kidney disease (CKD), particularly within the East Asian population, remains limited. We evaluated the clinical outcomes of ticagrelor-based versus clopidogrel-based dual antiplatelet therapy in Chinese patients with moderate-to-advanced CKD undergoing percutaneous coronary intervention (PCI).
Methods
We enrolled P2Y12 inhibitor-naïve Chinese patients with CKD stages 3–5 who underwent PCI for acute coronary syndrome between 2017 and 2023. The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and major bleeding events at 1-year post-PCI. The secondary endpoints included net adverse clinical events (NACE), all-cause death, cardiovascular death, myocardial infarction, and ischemic stroke. The primary analysis was performed using 1:1 propensity score matching, with findings further validated using multivariable Cox regression and inverse probability of treatment weighting.
Results
A total of 10,730 patients were enrolled, of which 2,750 had CKD stages 4–5. After 1:1 propensity score matching, ticagrelor yielded MACCE rates (hazard ratio [HR]: 1.15; 95% confidence interval [CI]: 0.93–1.42) compared to clopidogrel, but a significantly higher risk of major bleeding (HR: 1.35; 95% CI: 1.09–1.68), resulting in increased risk of NACE (HR: 1.26; 95% CI: 1.07–1.49). These differences were primarily observed in patients with CKD stages 4–5 and not in those with CKD stage 3.
Conclusion
The risk–benefit ratio of ticagrelor in East Asian CKD populations was found to be suboptimal, warranting a re-evaluation of antiplatelet drug selection strategies in this population.
Forest plot of clinical outcomes comparing ticagrelor versus clopidogrel stratified by chronic kidney disease stage. For ticagrelor compared to clopidogrel (reference), hazard ratios with 95% confidence intervals are provided for the total population and segmented by CKD stage. The incidence is expressed per 100 person-years. The dashed line indicates HR = 1.0.