Ticagrelor vs. clopidogrel in bivalirudin-treated patients with STEMI undergoing primary PCI: The BRIGHT-4 trial
Abstract
Background and aims
The optimal antiplatelet agent regimen in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) with bivalirudin anticoagulation is uncertain. This analysis sought to evaluate the safety and efficacy of ticagrelor compared with clopidogrel in patients with STEMI treated with PPCI with radial artery access and bivalirudin anticoagulation.
Methods
This post-hoc analysis compared bivalirudin plus ticagrelor with bivalirudin plus clopidogrel in 3009 BRIGHT-4 patients that were treated with PPCI. The primary endpoint was all-cause death or Bleeding Academic Research Consortium (BARC) types 3–5
bleeding occurring within 30 days.
Results
The 30-day all-cause death or BARC types 3–5 bleeding occurred in 2.0 % of patients treated with ticagrelor vs. 3.9 % of patients treated with clopidogrel (HR 0.51, 95 % CI 0.29 to 0.89;
P = 0.02), driven by a reduction in all-cause death with ticagrelor (1.9 % vs. 3.7 %; P = 0.02) with no difference in BARC types 3–5 bleeding (0.1 % vs. 0.3 %;
P = 0.34), although BARC type 2 bleeding was increased with ticagrelor (2.7 % vs. 1.2 %; P = 0.02). There was no significant difference between two groups in risk of stent thrombosis and composite of all-cause death, recurrent myocardial infarction, ischemia-driven target vessel revascularization, or stroke.