Effectiveness of clopidogrel vs. ticagrelor based on the ABCD-GENE score in acute coronary syndrome patients following percutaneous coronary intervention
AimThis study employs the ABCD-GENE score (age, body mass index, chronic kidney disease, diabetes, and CYP2C19 variants) to compare the effectiveness and safety of clopidogrel versus ticagrelor-based DAPT in ACS patients post-PCI.MethodsA total of consecutive 21,705 ACS patients who underwent PCI be...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2025.1606327/full |
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| author | Xiaotong Xu Xiaotong Xu Kun Na Miaohan Qiu Xueqing Yang Xueqing Yang Zizhao Qi Zizhao Qi Jing Li Kai Xu Xiaozeng Wang Yi Li Yaling Han |
| author_facet | Xiaotong Xu Xiaotong Xu Kun Na Miaohan Qiu Xueqing Yang Xueqing Yang Zizhao Qi Zizhao Qi Jing Li Kai Xu Xiaozeng Wang Yi Li Yaling Han |
| author_sort | Xiaotong Xu |
| collection | DOAJ |
| description | AimThis study employs the ABCD-GENE score (age, body mass index, chronic kidney disease, diabetes, and CYP2C19 variants) to compare the effectiveness and safety of clopidogrel versus ticagrelor-based DAPT in ACS patients post-PCI.MethodsA total of consecutive 21,705 ACS patients who underwent PCI between March 2016 and March 2023 and survived at discharge were included. The primary outcome was a composite of ischemic and bleeding events within 12 months, including cardiac death, myocardial infarction, ischemic stroke, and BARC types 3 or 5 bleeding. Propensity score matching was performed to balance baseline characteristics between clopidogrel and ticagrelor-based DAPT.ResultsIn the ABCD-GENE score <10 group, (4,748 matched pairs), ticagrelor increased BARC 3 or 5 bleeding (1.9% vs. 1.1%; HR: 1.52; 95% CI, 1.18–1.96; P = 0.0018), with no difference in the primary outcome (3.0% vs 3.5%; HR: 1.17; 95% CI: 0.94–1.46; P = 0.17) or ischemic events (2.0% vs 1.6%; HR: 0.82; 95% CI: 0.60–1.10; P = 0.19), compared with clopidogrel. In the ABCD-GENE score ≥10 group (1,231 matched pairs), ticagrelor significantly reduced the primary outcome (4.1% vs 6.0%; HR: 0.67; 95% CI: 0.47–0.96; P = 0.0272), driven by reduced rates of ischemic events (2.2% vs 4.5%; HR: 0.57; 95% CI: 0.38–0.85; P = 0.0015), without an increase in BARC 3 or 5 bleeding (1.9% vs. 1.7%; HR: 1.08; 95% CI, 0.60–1.96; P = 0.79), compared with clopidogrel.ConclusionThe ABCD-GENE score showed good predictive accuracy for a composite of ischemic and bleeding events and could identify patients likely to benefit from the ticagrelor-based antiplatelet strategy. |
| format | Article |
| id | doaj-art-15a4f9af1c564b3f9901a111223bef25 |
| institution | DOAJ |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-15a4f9af1c564b3f9901a111223bef252025-08-20T03:10:02ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-06-011610.3389/fphar.2025.16063271606327Effectiveness of clopidogrel vs. ticagrelor based on the ABCD-GENE score in acute coronary syndrome patients following percutaneous coronary interventionXiaotong Xu0Xiaotong Xu1Kun Na2Miaohan Qiu3Xueqing Yang4Xueqing Yang5Zizhao Qi6Zizhao Qi7Jing Li8Kai Xu9Xiaozeng Wang10Yi Li11Yaling Han12State Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, ChinaSchool of Life Science and Biochemistry, Shenyang Pharmaceutical University, Shenyang, ChinaState Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, ChinaState Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, ChinaState Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, ChinaDepartment of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, ChinaState Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, ChinaDepartment of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, ChinaState Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, ChinaState Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, ChinaState Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, ChinaState Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, ChinaState Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, ChinaAimThis study employs the ABCD-GENE score (age, body mass index, chronic kidney disease, diabetes, and CYP2C19 variants) to compare the effectiveness and safety of clopidogrel versus ticagrelor-based DAPT in ACS patients post-PCI.MethodsA total of consecutive 21,705 ACS patients who underwent PCI between March 2016 and March 2023 and survived at discharge were included. The primary outcome was a composite of ischemic and bleeding events within 12 months, including cardiac death, myocardial infarction, ischemic stroke, and BARC types 3 or 5 bleeding. Propensity score matching was performed to balance baseline characteristics between clopidogrel and ticagrelor-based DAPT.ResultsIn the ABCD-GENE score <10 group, (4,748 matched pairs), ticagrelor increased BARC 3 or 5 bleeding (1.9% vs. 1.1%; HR: 1.52; 95% CI, 1.18–1.96; P = 0.0018), with no difference in the primary outcome (3.0% vs 3.5%; HR: 1.17; 95% CI: 0.94–1.46; P = 0.17) or ischemic events (2.0% vs 1.6%; HR: 0.82; 95% CI: 0.60–1.10; P = 0.19), compared with clopidogrel. In the ABCD-GENE score ≥10 group (1,231 matched pairs), ticagrelor significantly reduced the primary outcome (4.1% vs 6.0%; HR: 0.67; 95% CI: 0.47–0.96; P = 0.0272), driven by reduced rates of ischemic events (2.2% vs 4.5%; HR: 0.57; 95% CI: 0.38–0.85; P = 0.0015), without an increase in BARC 3 or 5 bleeding (1.9% vs. 1.7%; HR: 1.08; 95% CI, 0.60–1.96; P = 0.79), compared with clopidogrel.ConclusionThe ABCD-GENE score showed good predictive accuracy for a composite of ischemic and bleeding events and could identify patients likely to benefit from the ticagrelor-based antiplatelet strategy.https://www.frontiersin.org/articles/10.3389/fphar.2025.1606327/fullCYP2C19 polymorphismABCD-GENE scoreclopidogrelticagrelorpercutaneous coronary intervention |
| spellingShingle | Xiaotong Xu Xiaotong Xu Kun Na Miaohan Qiu Xueqing Yang Xueqing Yang Zizhao Qi Zizhao Qi Jing Li Kai Xu Xiaozeng Wang Yi Li Yaling Han Effectiveness of clopidogrel vs. ticagrelor based on the ABCD-GENE score in acute coronary syndrome patients following percutaneous coronary intervention Frontiers in Pharmacology CYP2C19 polymorphism ABCD-GENE score clopidogrel ticagrelor percutaneous coronary intervention |
| title | Effectiveness of clopidogrel vs. ticagrelor based on the ABCD-GENE score in acute coronary syndrome patients following percutaneous coronary intervention |
| title_full | Effectiveness of clopidogrel vs. ticagrelor based on the ABCD-GENE score in acute coronary syndrome patients following percutaneous coronary intervention |
| title_fullStr | Effectiveness of clopidogrel vs. ticagrelor based on the ABCD-GENE score in acute coronary syndrome patients following percutaneous coronary intervention |
| title_full_unstemmed | Effectiveness of clopidogrel vs. ticagrelor based on the ABCD-GENE score in acute coronary syndrome patients following percutaneous coronary intervention |
| title_short | Effectiveness of clopidogrel vs. ticagrelor based on the ABCD-GENE score in acute coronary syndrome patients following percutaneous coronary intervention |
| title_sort | effectiveness of clopidogrel vs ticagrelor based on the abcd gene score in acute coronary syndrome patients following percutaneous coronary intervention |
| topic | CYP2C19 polymorphism ABCD-GENE score clopidogrel ticagrelor percutaneous coronary intervention |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2025.1606327/full |
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