{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T01:59:43Z","timestamp":1785117583964,"version":"3.55.0"},"reference-count":29,"publisher":"IMR Press","issue":"5","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Tianjin Key Medical Discipline Construction Project","award":["TJYXZDXK-3-006B"],"award-info":[{"award-number":["TJYXZDXK-3-006B"]}]},{"name":"Key project of Tianjin Natural Science Foundation","award":["21JCZDJC01080"],"award-info":[{"award-number":["21JCZDJC01080"]}]},{"name":"Tianjin Fourth Central Hospital's 2023 Outstanding Young Talent Fund","award":["tjdszxyy20230008"],"award-info":[{"award-number":["tjdszxyy20230008"]}]},{"name":"National Science and Technology Innovation 2030, Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2024ZD0524300"],"award-info":[{"award-number":["2024ZD0524300"]}]},{"name":"National Science and Technology Innovation 2030, Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2024ZD0524301"],"award-info":[{"award-number":["2024ZD0524301"]}]},{"name":"Tianjin Youth Project","award":["TJWJ2022QN048"],"award-info":[{"award-number":["TJWJ2022QN048"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Background: Dual antiplatelet therapy is essential for managing ST-elevation myocardial infarction (STEMI); however, the optimal choice of P2Y12 inhibitor in patients with thrombocytosis remains unclear. Therefore, this study aimed to compare the effects of clopidogrel and ticagrelor on the prognosis of patients with STEMI and platelet counts exceeding 350 \u00d7 109\/L. Methods: Utilizing data from the Tianjin Health and Medical Big Data platform (2010\u20132023), this retrospective cohort study included patients with acute myocardial infarction from 82 hospitals. After propensity score matching, 461 patients were assigned to two groups: ticagrelor and clopidogrel. Kaplan\u2013Meier curves and Cox regression analyses were employed to evaluate outcomes, with major adverse cardiac and cerebrovascular events (MACCEs) as the primary outcome. Secondary outcomes included net adverse clinical events (NACEs), all-cause mortality, cardiac mortality, recurrent non-fatal myocardial infarction, coronary revascularization, cerebral infarction, and bleeding events (Bleeding Academic Research Consortium (BARC) types 3\u20135). A MACCE was defined as a composite of cardiac mortality, recurrent non-fatal myocardial infarction, and cerebral infarction, while a NACE encompassed a MACCE plus bleeding events (BARC types 3\u20135). Results: Ticagrelor significantly reduced MACCEs (6.9% versus 12.1%; p = 0.008), all-cause mortality (3.9% versus 9.5%; p &lt; 0.001), cardiac mortality (3.5% versus 7.4%; p = 0.0096), and NACEs (8.2% versus 13.0%; p = 0.021) compared with clopidogrel. Exploratory multivariable analysis confirmed an independent association of ticagrelor with reduced risks of MACCEs (adjusted hazard ratio (aHR) = 0.59; 95% confidence interval (CI), 0.37\u20130.93), NACEs (aHR = 0.64; 95% CI, 0.42\u20130.98), and all-cause mortality (aHR = 0.47; 95% CI, 0.26\u20130.83). Conclusions: Ticagrelor was associated with superior clinical outcomes in patients with STEMI and elevated admission platelet counts (\u2265350 \u00d7 109\/L) compared with clopidogrel. In contrast to genetic testing, which is costly, time-consuming (\u226524\u201372 hours), and impractical in emergencies, this simple, universally available platelet count threshold offers an immediate, practical biomarker for selecting potent P2Y12 inhibition in acute settings.<\/jats:p>","DOI":"10.31083\/rcm46358","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T01:28:22Z","timestamp":1785115702000},"source":"Crossref","is-referenced-by-count":0,"title":["Ticagrelor Versus Clopidogrel in Patients With ST-Elevation Myocardial Infarction and Elevated Platelet Counts: A Multicenter Comparative Analysis of Ischemic Outcomes"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9429-4535","authenticated-orcid":true,"given":"Fang-Jie","family":"Ji","sequence":"first","affiliation":[{"name":"Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, 300211 Tianjin, China"},{"name":"Department of Cardiology, The Fourth Central Hospital Affiliated to Tianjin Medical University, 300140 Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1720-6788","authenticated-orcid":true,"given":"Xian","family":"Shao","sequence":"additional","affiliation":[{"name":"Division of Nephrology, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8200-4093","authenticated-orcid":true,"given":"Tian-Shu","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, 300211 Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1622-4103","authenticated-orcid":true,"given":"Yu-Kun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, 300211 Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6852-8538","authenticated-orcid":true,"given":"Su-Tao","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, 300211 Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1832-7215","authenticated-orcid":true,"given":"Chao","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, 300211 Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0816-4759","authenticated-orcid":true,"given":"Jing-Kun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, University of California, San Francisco, CA 94158, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8637-3156","authenticated-orcid":true,"given":"Xue","family":"Wu","sequence":"additional","affiliation":[{"name":"Institute for Global Health Sciences, University of California, San Francisco, CA 94158, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9456-9852","authenticated-orcid":true,"given":"Seung-Woon","family":"Rha","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Guro Hospital, 08308 Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3034-5179","authenticated-orcid":true,"given":"Xing","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, 300211 Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0482-0738","authenticated-orcid":true,"given":"Tong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, 300211 Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7056-6438","authenticated-orcid":true,"given":"Kang-Yin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, 300211 Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Yan Y, Gong W, Ma C, Wang X, Smith SC, Jr, Fonarow GC, et al. 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