Ticagrelor vs. Clopidogrel in ACS Patients Underwent PCI: An Analysis Based on Systemic Immune-inflammation Risk Stratification.

Authors

Hengbo Zhai, Miaohan Qiu, Kun Na, Yang Li, Chenghui Yan, Yi Li, Yaling Han

Published in

Thrombosis and haemostasis. Sep 23, 2026. Epub Sep 23, 2026.

Abstract

The systemic immune-inflammation index (SII) is an established prognostic marker in coronary artery disease. This study investigated the association between SII and 1-year prognosis in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), and explored its potential utility in informing P2Y₁₂ inhibitor selection.
A total of 15,123 consecutive ACS patients undergoing PCI between January 2021 and December 2022 were enrolled. Patients were stratified into high- and low-inflammation groups based on the optimal SII cut-off derived from receiver operating characteristic analysis. The primary endpoint was 12-month ischemic events, defined as a composite of cardiac death, myocardial infarction, and stroke. Propensity-score matching was performed to compare ticagrelor-based versus clopidogrel-based dual antiplatelet therapy within each group.
The optimal SII cut-off was 651 × 10⁹/L. Elevated SII was associated with increased ischemic events (HR 1.86; 95% CI: 1.52-2.28; p < 0.0001) and all-cause mortality (HR 2.44; 95% CI: 1.90-3.13; p < 0.0001). In the low-SII group (1,422 matched pairs), ticagrelor was associated with increased bleeding risk (HR 2.15; 95% CI: 1.60-2.88; p < 0.0001) without association with ischemic benefit. In the high-SII group (1,299 matched pairs), ticagrelor was associated with reduced ischemic events (HR 0.52; 95% CI: 0.33-0.83; p = 0.006), cardiac death (HR 0.45; 95% CI: 0.23-0.86; p = 0.015), and all-cause mortality (HR 0.40; 95% CI: 0.23-0.70; p = 0.001) without association with increased major bleeding.
The SII is associated with 12-month post-PCI ischemic and mortality risk and demonstrates potential as a candidate biomarker for risk stratification, with exploratory observations of ticagrelor benefit in high-SII and clopidogrel adequacy in low-SII patients.

PMID:
42778156
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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