BACKGROUND Risk stratification with specific biomarkers is proposed for tailored P2Y12 inhibitor therapy in patients with STEMI. METHODS This nationwide registry and quality improvement study is from November 1, 2014, to June 30, 2017. In total, 11,512 STEMI patients received aspirin and P2Y12 receptor inhibitor (clopidogrel or ticagrelor) and underwent PCIs in hospitals. Of the patients, 2992 were prescribed ticagrelor and 8520 clopidogrel. The primary effectiveness outcome was major adverse cardiovascular and cerebrovascular events (MACCE: cardiac death, myocardial infarction, stent thrombosis, in-hospital ischemic stroke). The primary safety outcome was in-hospital major bleeding. RESULTS MACCE incidence was lower in the ticagrelor group than in the clopidogrel group (0.8% versus 1.2%; P=0.046), but under different NT-proBNP levels, cumulative hazards of MACCE were without statistical significance. Bleeding rates were higher in the ticagrelor group than in the clopidogrel group (all bleeding: 9.9% versus 6.9%, P<0.001; major bleeding: 4.0% versus 2.7%, P<0.001). The higher cumulative hazard of bleeding could be identified in the Kaplan-Meier curves. In the multivariate analysis, ticagrelor increased bleeding events, compared with clopidogrel, at NT-proBNP >1800 ng/L patients (all bleeding: HR 1.46; 95%CI, 1.07-2.01; major bleeding: HR 1.68, 95%CI, 1.03-2.74), but a low effect was found in those with lower NT-proBNP level. Subgroup analyses show that ticagrelor increased major bleeding in patients with left ventricular ejection fraction (LVEF) <0.50 (HR 3.29; 95% CI 1.61-6.74) (interaction p=0.03). CONCLUSION We found that ticagrelor, compared with clopidogrel, increased bleeding complications in hospitalized patients with NT-proBNP>1800 ng/L, especially in patients with EF < 0.50.

中文翻译：

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NT-proBNP下氯吡格雷和替卡格雷对住院ST段抬高急性冠脉综合征患者经皮冠状动脉介入治疗的疗效：CCC-ACS项目分析。

背景技术针对特定的STEMI患者P2Y12抑制剂疗法，提出了使用特定生物标记物进行风险分层的方案。方法这项全国性的注册和质量改善研究于2014年11月1日至2017年6月30日进行。总共有11,512例STEMI患者接受了阿司匹林和P2Y12受体抑制剂（氯吡格雷或替卡格雷）的治疗，并在医院接受了PCI。在这些患者中，有2992个处方的替加格雷和8520个氯吡格雷。主要疗效结果是主要的不良心血管和脑血管事件（MACCE：心源性死亡，心肌梗塞，支架血栓形成，医院内缺血性中风）。主要安全结果是院内大出血。结果替卡格雷组的MACCE发生率低于氯吡格雷组（0.8％比1.2％； P = 0.046），但是在不同的NT-proBNP水平下，MACCE的累积危害无统计学意义。替卡格雷组的出血率高于氯吡格雷组（所有出血：9.9％比6.9％，P <0.001；大出血：4.0％比2.7％，P <0.001）。在Kaplan-Meier曲线中可以确定较高的累积出血危险。在多变量分析中，与氯吡格雷相比，在NT-proBNP> 1800 ng / L的患者中替卡格雷增加了出血事件（所有出血：HR 1.46; 95％CI，1.07-2.01;大出血：HR 1.68，95％CI，1.03 -2.74），但在NT-proBNP水平较低的人群中效果较差。亚组分析显示，替卡格雷在左室射血分数（LVEF）<0.50（HR 3.29; 95％CI 1.61-6.74）的患者中增加了大出血（相互作用p = 0.03）。结论我们发现替卡格雷与氯吡格雷相比，