A Retrospective Cohort Study on Long-TermOutcomes of Ticagrelor Versus Clopidogrel After Retrograde Percutaneous Coronary Intervention for Chronic Total Occlusion
Am J Cardiovasc Drugs. 2025 Jul 12. doi:10.1007/s40256-025-00750-z.
Abstract
Background: Chronic total occlusion (CTO) affects 15-25% of patients undergoing coronary angiography, and successful percutaneous coronary intervention (PCI) can improve ischemia, angina symptoms, and overall quality of life. However, Chronic total occlusion - percutaneous coronary intervention is a complex procedure with higher risks of acute thrombosis, restenosis, and long-term thrombosis due to factors such as longer lesion length, calcification, and the need for more stents. Dual antiplatelet therapy (DAPT) is essential after percutaneous coronary intervention, but theoptimal regimen for Chronic total occlusion, particularly in patients with chronic coronary syndrome, remains under debate. Although more potent P2Y12 inhibitors such as ticagrelor may offer benefits in some cases, recent studieshave shown mixed results.
Objective: This study aimed to assess the effect of potent Dual antiplatelet therapy on long-term outcomes in patients with Chronic total occlusion undergoing retrograde percutaneous coronary intervention.
Method: We conducted a retrospective analysis of836 consecutive patients who underwent elective retrograde Chronic total occlusion - percutaneous coronary intervention at a single center between January 2011 and April 2023. We compared patient and lesion characteristics,procedural details and results, and long-term outcomes between patients who received ticagrelor and those who received clopidogrel after retrograde Chronic total occlusion - percutaneous coronary intervention.
Result: Clinical follow-up was available in 767 (91.2%) patients, with a median follow-up of 1041 days (range 531-1511). The risk of major adverse cardiovascular events was significantly lower in patients receiving ticagrelor than in those receiving clopidogrel (8.8% vs. 18.5%, p = 0.005),primarily due to reductions in all-cause mortality (1.9% vs. 8.1%, p = 0.009) and cardiac death (0.6% vs. 5.8%, p =0.012).
Conclusion: Dual antiplatelet therapy with ticagrelor may represent a safe and efficient management strategy for patients undergoing retrograde Chronic total occlusion - percutaneous coronary intervention.
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