Key result
Ticagrelor showed no significant difference in major adverse cardiovascular events compared to clopidogrel in East Asian patients with acute coronary syndrome (RR 0.87; 95% CI 0.52-1.45; P=.58).
Why the study?
Current guidelines recommend ticagrelor over clopidogrel for patients with acute coronary syndrome, but its benefit and risk in East Asians remain unclear.
Does ticagrelor reduce major adverse cardiovascular events or increase bleeding compared to clopidogrel in East Asian patients with acute coronary syndrome?
Meta-Analysis (n=2,752)
Does ticagrelor reduce major adverse cardiovascular events or increase bleeding compared to clopidogrel in East Asian patients with acute coronary syndrome?
Relative Risk: 0.87 (95% CI 0.52–1.45)
p-value: p=.58
In East Asian patients with acute coronary syndrome, ticagrelor does not significantly reduce major adverse cardiovascular events compared to clopidogrel but significantly increases the risk of bleeding.
No MACE benefit with ticagrelor versus clopidogrel in East Asian ACS; challenges universal recommendations and supports ethnicity-specific trials.
BACKGROUND: Although current guidelines recommend ticagrelor to clopidogrel for patients with acute coronary syndrome, its benefit and risk are unclear for East Asians. This meta-analysis was performed to assess the efficacy and safety of ticagrelor in East Asian patients with acute coronary syndrome. METHODS: Medline, EMBASE, and Cochrane Databases were searched from inception to July, 2021, for randomized controlled trials comparing ticagrelor with clopidogrel in East Asian patients with acute coronary syndrome. Major adverse cardiovascular events and bleeding events were assessed by using Mantel-Haenszel-pooled risk ratio and 95% con- fidence interval. RESULTS: Five randomized controlled trials identified 2752 patients with acute coronary syndrome. Compared with clopidogrel, ticagrelor had no statistical difference of major adverse cardiovascular events (RR 0.87; 95% CI 0.52-1.45; P = .58), all cause death (RR 0.90, 95% CI 0.62-1.32; P = .60), cardiovascular death (RR 0.90, 95% CI 0.47-1.72; P = .74), myo- cardial infarction (RR 0.91, 95% CI 0.52-1.58; P = .73), and stroke (RR 0.87, 95% CI 0.48-1.57; P = .64). Despite ticagrelor did not increase the incidence of fatal bleeding (RR 2.49, 95% CI 0.79-7.87; P = 0.12), the risks of all bleeding (RR 1.71, 95% CI 1.36-2.16; P < .00001), major bleeding (RR 1.51, 95% CI 1.12-2.04; P = .007), non-coronary artery bypass grafting major bleeding (RR 1.83, 95% CI 1.23-2.71; P = .003), and minor bleeding (RR 1.92, 95% CI 1.40-2.64; P < .0001) were significantly higher. CONCLUSIONS: Although there was no significant difference in the incidence of fatal bleed- ing, ticagrelor displayed similar efficacy and dramatically increased the risk of otherbleeding events.
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Xie et al. (2022) conducted a meta-analysis in acute coronary syndrome (n=2,752). Ticagrelor vs. Clopidogrel was evaluated on Major adverse cardiovascular events (RR 0.87, 95% CI 0.52-1.45, p=.58). Ticagrelor showed no significant difference in major adverse cardiovascular events compared to clopidogrel in East Asian patients with acute coronary syndrome (RR 0.87; 95% CI 0.52-1.45; P=.58).
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