Supplementary Material for: Real-world data on potent P2Y12-inhibition in patients with suspected chronic coronary syndrome, referred for coronary angiography

Introduction Potential benefit with potent platelet inhibition in patients with chronic coronary syndrome (CCS), undergoing percutaneous coronary intervention (PCI) has been discussed. The aim of this study was to compare a potent P2Y12 inhibition strategy using ticagrelor with clopidogrel, in CCS patients referred for coronary angiography (CA) and PCI if feasible. Methods In this retrospective real-world study, patients referred for outpatient CA due to suspected CCS were included. To adjust for group differences, a propensity score reflecting the probability of being treated with ticagrelor was calculated and added to the logistic regression outcome model. Results In total 1 003 patients were included in the primary analysis (577 treated with clopidogrel and 426 with ticagrelor). Among clopidogrel treated patients 132 (22.9%) experienced a bleeding complication compared with 93 (21.8%) among ticagrelor treated patients, with no significant difference between the groups (p=0.70). There was no difference in bleeding severity. Furthermore, we observed no statistically significant difference in major adverse cardiovascular event (MACE [death, stent thrombosis, myocardial infarction or stroke]), (1.2% vs 2.3%, p=0.17). A subgroup analysis restricted to patients undergoing PCI ad hoc displayed a similar pattern. Also patients undergoing CA without PCI ad hoc frequently experienced a bleeding complication, with no difference between the two treatments (21.0 % vs 17.3%, p=0.27). Propensity score adjusted analyses confirmed the results. Discussion/Conclusion In patients with CCS referred for CA and PCI if feasible, a more potent P2Y12 inhibition strategy with ticagrelor was not associated with bleeding complications or MACE compared with clopidogrel.

引言
针对拟行经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）的慢性冠状动脉综合征（chronic coronary syndrome, CCS）患者，强效血小板抑制治疗的潜在获益已被广泛探讨。本研究旨在对比在拟行冠状动脉造影（coronary angiography, CA）且可行时行经皮冠状动脉介入治疗的慢性冠状动脉综合征患者中，采用替格瑞洛与氯吡格雷的强效P2Y12抑制策略的差异。

方法
本研究为回顾性真实世界研究，纳入因疑似慢性冠状动脉综合征行门诊冠状动脉造影的患者。为校正组间差异，本研究计算了反映患者接受替格瑞洛治疗概率的倾向评分，并将其纳入logistic回归结局模型。

结果
本研究初始分析共纳入1003例患者，其中577例接受氯吡格雷治疗，426例接受替格瑞洛治疗。接受氯吡格雷治疗的患者中，132例（22.9%）发生出血并发症；接受替格瑞洛治疗的患者中为93例（21.8%），两组差异无统计学意义（p=0.70）。两组出血严重程度无差异。此外，两组在主要不良心血管事件（major adverse cardiovascular event, MACE，包括死亡、支架血栓形成、心肌梗死或卒中）的发生率上无统计学显著差异（1.2% vs 2.3%，p=0.17）。针对仅接受即时经皮冠状动脉介入治疗的患者进行的亚组分析，亦显示出相似的结果模式。此外，仅行冠状动脉造影而未接受即时经皮冠状动脉介入治疗的患者中，亦常发生出血并发症，两组治疗方案的出血并发症发生率无差异（21.0% vs 17.3%，p=0.27）。经倾向评分校正的分析亦验证了上述结果。

讨论/结论
对于拟行冠状动脉造影且可行时行经皮冠状动脉介入治疗的慢性冠状动脉综合征患者，与氯吡格雷相比，采用替格瑞洛的更强效P2Y12抑制策略并未增加出血并发症或主要不良心血管事件的发生风险。