A Comparison of the Effects of Ticagrelor and Clopidogrel in Patients with Acute ST-Segment Elevation Myocardial Infarction: A systematic review and Meta-analysis

Background Rupture of unstable coronary atherosclerotic plaque leads to acute ST segment elevation myocardial infarction which is the most critical type of acute coronary syndrome. Dual anti-platelet therapy is one the main treatments and the combination of Aspirin and Clopidogrel is recognized as the standard oral regimen in most cases. Ticagrelor is a new generation of P2Y12 receptor inhibitors, which is a direct P2Y12 receptor antagonist. The goal of this study is to compare the effect of Ticagrelor and Clopidogrel in treatment of STEMI. Methods In this study, Pub Med, Scopus, Google Scholar Web of Science, Embase and Cochrane library clinical trials.gov databases were investigated. Inhomogeneity between studies was assessed using the I2 index and the Q statistic. The random effects model was used to combine studies. The Funnel plot and Egger's test were used to assess the publication bias. A probability value of less than 5 percent was considered a significant level. Results Eleven studies were included in this meta-analysis. Five thousand two hundred seventy-four patients in the Ticagrelor group and 5,295 patients in the Clopidogrel group were examined. The mean (standard deviation) age of the patients was 58.84 years (2.70) and 59.92 years (3.19) in the Ticagrelor group and the Clopidogrel group, respectively. Based on the results of the meta-analysis, compared to Clopidogrel, Ticagrelor had a protective effect on the outcomes of recurrent myocardial infarction, stroke, Major Adverse Cardiovascular Events (MACE), post-myocardial infarction bleeding according to Bleeding Academic Research Consortium (BARC) criteria, mortality, and reperfusion state regarding thrombolysis in myocardial infarction (TIMI) Flow Grading system. However, this effect was not statistically significant, and the publication bias was not statistically significant either. Conclusions According to the present study, although Ticagrelor increased the chance of bleeding according to the BARC score, compared to Clopidogrel, there was more improvement in TIMI score and fewer problems related to stroke, mortality, MI, and MACE in patients who took Ticagrelor.