Key result
Ticagrelor monotherapy reduces MACE ~14% vs aspirin monotherapy after coronary revascularization.
Why the study?
To compare the efficacy and safety of ticagrelor monotherapy versus aspirin monotherapy in patients with coronary artery disease undergoing coronary revascularization.
Does ticagrelor monotherapy reduce major adverse cardiovascular events compared to aspirin monotherapy in patients with coronary artery disease undergoing coronary revascularization?
Meta-Analysis (n=25,994)
Does ticagrelor monotherapy reduce major adverse cardiovascular events compared to aspirin monotherapy in patients with coronary artery disease undergoing coronary revascularization?
Ticagrelor monotherapy after coronary revascularization significantly reduces MACE and all-cause mortality compared to aspirin monotherapy, without increasing the risk of major bleeding.
Answers are grounded in this paper and cite their sources.
Ticagrelor monotherapy may be preferred over aspirin after revascularization to reduce MACE; confirms benefit across pooled RCTs.
Objective To compare the efficacy and safety of ticagrelor monotherapy versus aspirin monotherapy in patients with coronary artery disease undergoing coronary revascularization. Methods We conducted a systematic review and meta-analysis of RCTs comparing ticagrelor monotherapy with aspirin monotherapy after PCI or CABG. MEDLINE, Embase, Cochrane Central, Scopus, ClinicalTrials.gov and Google Scholar were searched up to 19th January 2026. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause mortality, myocardial infarction and stroke. Secondary outcomes included all-cause mortality, myocardial infarction, stroke, major bleeding, repeat revascularization and stent thrombosis. Risk ratios (RRs) with 95% CIs were pooled using a random-effects model with restricted maximum likelihood estimation and Knapp-Hartung adjustment. Results Five randomised trials involving 25,994 participants were included, of whom 12,998 received ticagrelor monotherapy and 12,996 received aspirin monotherapy. Ticagrelor monotherapy was associated with a significantly lower risk of MACE than aspirin monotherapy (RR 0.86, 95% CI 0.78 to 0.95; p = 0.012; I² = 0%). All-cause mortality was also reduced with ticagrelor (RR 0.86, 95% CI 0.77 to 0.97; p = 0.023; I² = 0%). No significant differences were observed for myocardial infarction (RR 0.87, 95% CI 0.70 to 1.07; p = 0.138; I² = 0%), stroke (RR 1.01, 95% CI 0.85 to 1.19; p = 0.913; I²=0%), major bleeding (RR 1.00, 95% CI 0.84 to 1.20; p = 0.976; I² = 0%), repeat revascularization (RR 0.89, 95% CI 0.58 to 1.37; p = 0.452; I² = 45.8%) or stent thrombosis (RR 0.88, 95% CI 0.20 to 3.90; p = 0.481; I² = 0%). Conclusion Ticagrelor monotherapy was associated with a potential reduction in MACE and all-cause mortality compared with aspirin monotherapy after coronary revascularisation, without increasing major bleeding. However, these findings were driven primarily by PCI trials, particularly the GLOBAL LEADERS and GLASSY trial program, and should be interpreted cautiously because PCI and CABG populations were analyzed together. Trial registratrion CRD420261286239
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Regmi et al. (2026) conducted a meta-analysis in coronary artery disease undergoing coronary revascularization (n=25,994). Ticagrelor monotherapy vs. Aspirin monotherapy was evaluated on major adverse cardiovascular events (MACE), a composite of all-cause mortality, myocardial infarction and stroke (RR 0.86, 95% CI 0.78 to 0.95, p=0.012). Ticagrelor monotherapy significantly reduced the risk of MACE compared with aspirin monotherapy after coronary revascularization (RR 0.86; 95% CI 0.78 to 0.95; p=0.012).
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