December 26, 2023Journal of Interventional CardiologyOpen Access

Comparison of Ticagrelor and Clopidogrel in Elective Coronary Stenting: A Double Blind Randomized Clinical Trial

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Why the study?

Dual antiplatelet therapy with a P2Y12 inhibitor and aspirin is recommended after PCI to prevent myocardial infarction and stent thrombosis, prompting a comparison between clopidogrel and ticagrelor in elective PCI.

Does ticagrelor compared to clopidogrel affect the incidence of dyspnea and major adverse cardiovascular events in patients undergoing elective PCI?

Structured PICO

Does ticagrelor compared to clopidogrel affect the incidence of dyspnea and major adverse cardiovascular events in patients undergoing elective PCI?

Population

437 patients who had undergone elective percutaneous coronary intervention (PCI)

Intervention

Ticagrelor 90 mg twice daily plus aspirin 80 mg once daily

Comparator

Clopidogrel 75 mg once daily plus aspirin 80 mg once daily

Outcome

Dyspnea at rest (scored on a 10-point Likert scale) at 6 monthspatient reported

In patients undergoing elective PCI, ticagrelor reduces major adverse cardiovascular events compared to clopidogrel but is associated with a significantly higher rate of new-onset dyspnea.

Implication

Ticagrelor reduces death and stent thrombosis versus clopidogrel after elective PCI; extends potent P2Y12 evidence to stable patients.

Abstract

Background. Dual antiplatelet therapy with a P2Y12 inhibitor (e.g., clopidogrel and ticagrelor) and aspirin is recommended for at least one year after percutaneous coronary intervention (PCI) to prevent further myocardial infarction and stent thrombosis as the major adverse effects of PCI. Methods. This randomized clinical trial was conducted from October 2022 to March 2023. Patients who had undergone elective PCI were included in the study. Patients were randomized into two different groups. One group took ASA 80 mg and clopidogrel 75 mg once daily, while the other took ASA 80 mg once daily and ticagrelor 90 mg twice daily. After six months of close follow-up, patients were asked to score their dyspnea on a 10-point Likert scale. They were also asked about dyspnea on exertion, paroxysmal nocturnal dyspnea (PND), bleeding, and the occurrence of major adverse cardiovascular events (MACEs). Results. 223 patients were allocated to the clopidogrel group and 214 to the ticagrelor group. In the ticagrelor group, 95 patients (44.3%) reported dyspnea at rest, compared with only 44 patients (19.7%) in the clopidogrel group ( P < 0.001). MACEs occurred in 7 patients (2.8%) in the ticagrelor group, compared with 16 (7.6%) in the clopidogrel group ( P = 0.031). Eight patients (3.8%) reported bleeding with ticagrelor, as did seven (3.2%) with clopidogrel ( P = 0.799). Conclusions. New-onset dyspnea was recorded more frequently with ticagrelor than clopidogrel, yet fewer MACEs occurred with ticagrelor (ClinicalTrials.gov number: NCT05858918).