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Clinical Outcomes of Ticagrelor versus Clopidogrel in Patients with Chronic Kidney Disease and Acute Myocardial Infarction: A Real-World Cohort Study

Year: 2026

Type: article

Abstract: INTRODUCTION: Chronic kidney disease (CKD) is a major risk factor for cardiovascular morbidity and mortality, particularly in patients with acute myocardial infarction (AMI). Dual antiplatelet therapy is essential for secondary prevention in AMI, but the optimal P2Y12 inhibitor in CKD patients remains unclear. While ticagrelor has demonstrated superior cardiovascular outcomes compared to clopidogrel in the general population, its safety and efficacy in advanced CKD are not well established. METHODS: This retrospective cohort study analyzed data from the Chang Gung Research Database (CGRD) to compare ticagrelor and clopidogrel in CKD stage III-V patients hospitalized with AMI between 2001 and 2020. Inverse probability of treatment weighting was applied to balance baseline characteristics. Clinical outcomes, including recurrent AMI, ischemic stroke, cardiovascular death, major bleeding events, and all-cause mortality, were evaluated using Cox proportional hazards models and competing risk analysis. RESULTS: Among 3,461 patients (ticagrelor: 704, clopidogrel: 2,757), ticagrelor was associated with a significantly lower risk of all-cause mortality (HR 0.694, 95% CI 0.539-0.894, p = 0.047), with no significant differences in recurrent AMI, ischemic stroke, cardiovascular death, or major bleeding events. CONCLUSIONS: In CKD patients with AMI, ticagrelor was associated with reduced all-cause mortality compared to clopidogrel, without an increased risk of major bleeding. These findings highlight the need for further prospective studies to confirm ticagrelor's benefits and inform optimal antiplatelet strategies in this high-risk population.

Source: Cardiorenal Medicine

DOI: 10.1159/000550521