Background@#Although
ticagrelor is known to increase the
bleeding risk compared to
clopidogrel in
East Asian patients, its clinical benefits in
patients with acute
myocardial infarction (AMI) without high
bleeding risk (HBR) remains unknown. @*
Methods@#A total of 7,348
patients who underwent successful
percutaneous coronary intervention (PCI) from the
Korea Acute
Myocardial Infarction Registry-National Institute of
Health (KAMIR-NIH), between November 2011 and December 2015, were divided into two groups according to the Academic
Research Consortium for HBR criteria (KAMIR-HBR, 2,469
patients; KAMIR-non HBR, 4,879
patients). We compared in-
hospital major adverse cardiovascular events (MACEs, defined as a composite of
cardiac death, non-fatal
myocardial infarction, or
stroke), and the thrombolysis in
myocardial infarction (TIMI) major
bleeding between
ticagrelor and
clopidogrel in the KAMIR-HBR and the KAMIR-non HBR groups, respectively. @*Results@#After
propensity score matching,
ticagrelor had a higher
incidence of in-
hospital TIMI major
bleeding than
clopidogrel in all
patients (
odds ratio [OR], 1.683; 95%
confidence interval [CI], 1.010–2.805; P = 0.046) and the KAMIR-HBR group (OR, 3.460; 95% CI, 1.374–8.714; P = 0.008). However, there was no significant difference in in-
hospital TIMI major
bleeding between
ticagrelor and
clopidogrel in the KAMIR-non HBR group (OR, 1.436; 95% CI, 0.722–2.855; P = 0.303). No differences were observed in the
cumulative incidences of in-
hospital and 6-month MACEs between
ticagrelor and
clopidogrel in both groups. @*Conclusions@#The
bleeding risk of
ticagrelor was attenuated in Korean
patients with AMI without HBR. Appropriate
patient selection could reduce in-
hospital bleeding complications associated with
ticagrelor in Korean
patients with AMI
who underwent successful PCI.