Risk factors of ticagrelor-associated dyspnea in patients with acute coronary syndrome / 第二军医大学学报

ABSTRACT

Objective: To investigate the incidence, clinical characteristics and related risk factors of dyspnea in acute coronary syndrome (ACS) patients taking ticagrelor after percutaneous coronary intervention (PCI). Methods: This prospective study included 283 ACS patients under the treatment of ticagrelor after PCI from Dec. 2018 to Jun. 2019. Patients with lung diseases, cardiac insufficiency grade III or above (New York Heart Association [NYHA] heart function classification), or with medicine intervention were excluded from the study. Dyspnea was assessed by Borg scale. The hemorrhage was evaluated by thrombolysis in myocardial infarction (TIMI) bleeding classification. Risk factors of ticagrelor-related dyspnea were analyzed by one-way ANOVA and multivariable logistic regression analysis. Receiver operating characteristic (ROC) curve was drawn to calculate left ventricular ejection fraction (LVEF) in the diagnosis of ticagrelor-related dyspnea. Results: The incidence of ticagrelor-related dyspnea was 16.3% (46/283), and 60.9% (28/46) of the patients developed dyspnea within 1 week after taking ticagrelor. Mild dyspnea manifested in 56.5% (26/46) patients, moderate dyspnea in 28.3% (13/46) patients and severe dyspnea in 15.2% (7/46) patients. Discontinuation of ticagrelor due to adverse drug reactions accounted for 8.5% (24/283), and 62.5% (15/24) of them terminated ticagrelor because of intolerable dyspnea. The bleeding events, proportion of male patients, smoking history, and left atrial volume (LA) of the dyspnea group were significantly higher than those of the non-dyspnea group (all P<0.05). LVEF of the dyspnea group was significantly lower than that of the non-dyspnea group (P<0.01). Multivariate logistic regression analysis showed that bleeding events, low LVEF, male and smoking were independent risk factors for ticagrelor-related dyspnea (P<0.05). The risk of dyspnea in patients with bleeding events was 2.925 times higher than that in patients without bleeding events (odds ratio[OR]=2.925, 95% confdence interval [CI] 1.386-6.175, P=0.005). ROC curve analysis showed that the cut-off of LVEF for diagnosis of ticagrelor-related dyspnea was 61%. Conclusion: Ticagrelor-related dyspnea is very common in Chinese ACS patients. Mild dyspnea presents within 1 week after taking the drug in most patients. Bleeding events, low LVEF, smoking, and male are risk factors for ticagrelor-related dyspnea.