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Comment & Response
March 2, 2021

Ticagrelor vs Clopidogrel for Patients With Acute Coronary Syndrome Undergoing Percutaneous Intervention—Reply

Author Affiliations
  • 1Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
  • 2Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
  • 3Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA. 2021;325(9):890-891. doi:10.1001/jama.2020.26023

In Reply Dr Kim and colleagues state that the results of our study1 are not comparable with those of PLATO and suggest that our findings may differ because patients enrolled in PLATO had a higher proportion of prior myocardial infarction. First, as we mention in our article, PLATO failed to show benefit in North America and included few Asian patients. It did show that ticagrelor reduced ischemic events and increased the rate of nonprocedural bleeding. However, several studies have demonstrated that high-risk patients with ACS do not have a net benefit with ticagrelor. For example, the SWEDEHEART registry showed that ticagrelor was associated with higher rates of bleeding and increased mortality in patents with ACS who were aged 80 years or older. A reduction in ischemic outcomes from ticagrelor was also not observed in this study.2 The open-label randomized clinical trial POPular AGE demonstrated that clopidogrel is favored for older patients with non–ST-elevation ACS, a high-risk subgroup.3 The TICA-KOREA trial showed that ticagrelor use was not associated with fewer ischemic events but was associated with increased risk of bleeding in Korean patients with ACS treated with PCI.4