Key result
Ticagrelor did not significantly reduce all-cause mortality (RR 0.76) or major adverse cardiovascular events compared to clopidogrel in patients with chronic coronary syndrome undergoing percutaneous coronary intervention.
Why the study?
Does ticagrelor improve cardiovascular outcomes or reduce stent thrombosis compared to clopidogrel in patients with chronic coronary syndrome undergoing percutaneous coronary intervention?
Meta-Analysis (n=32,152)
Yes
Does ticagrelor improve cardiovascular outcomes or reduce stent thrombosis compared to clopidogrel in patients with chronic coronary syndrome undergoing percutaneous coronary intervention?
Relative Risk: 0.76 (95% CI 0.57–1.01)
Absolute Event Rate: 0.99% vs 1.26%
In patients with chronic coronary syndrome undergoing PCI, ticagrelor reduces stent thrombosis compared to clopidogrel but does not significantly improve mortality or MACE, highlighting the need for individualized antiplatelet selection.
Ticagrelor reduces stent thrombosis in CCS-PCI without mortality or MACE benefit; extends evidence supporting individualized antiplatelet selection.
Dual antiplatelet therapy (DAPT) is essential post-percutaneous coronary intervention (PCI), yet the optimal P2Y₁₂ inhibitor for chronic coronary syndrome (CCS) remains debated. While ticagrelor demonstrates superior efficacy in acute coronary syndromes (ACS), its role in CCS is unclear. This systematic review and meta-analysis compared ticagrelor versus clopidogrel in CCS patients undergoing PCI. We searched PubMed, Embase, Web of Science, and Cochrane CENTRAL from inception to May 2025. Five studies (two randomized controlled trials (RCTs) and three observational) comprising 32,152 patients were included. Though ticagrelor showed lower all-cause mortality compared to clopidogrel (0.99% vs. 1.26%; RR 0.76, 95% CI: 0.57-1.01), this difference was not statistically significant. Similarly, no significant differences were observed in major adverse cardiovascular events (MACE) (6.23% vs. 6.48%; RR 0.90, 95% CI: 0.70-1.15) or myocardial infarction (MI) (2.67% vs. 1.43%; RR 1.17, 95% CI: 0.94-1.44). Revascularization rates were numerically lower with ticagrelor (3.66% vs. 4.82%; RR 0.83, 95% CI: 0.68-1.01) but not significantly. Notably, ticagrelor significantly reduced stent thrombosis (RR 0.50, 95% CI: 0.26-0.97) without statistically significant increases in minor bleeding (RR 1.66, 95% CI: 0.97-2.85) or major bleeding (RR 1.28, 95% CI: 0.87-1.89). These findings suggest ticagrelor may offer advantages in preventing stent thrombosis but without significant differences in mortality, MACE, or MI compared to clopidogrel in CCS patients. While bleeding risk appears numerically higher with ticagrelor, differences were not statistically significant. Given limited high-quality data specifically for CCS patients, individualized antiplatelet selection balancing thrombotic and bleeding risks remains crucial, with larger RCTs needed to confirm these findings.
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Khan et al. (2025) conducted a meta-analysis in Chronic Coronary Syndrome (n=32,152). Ticagrelor vs. Clopidogrel was evaluated on All-cause mortality (RR 0.76, 95% CI 0.57-1.01). Ticagrelor did not significantly reduce all-cause mortality (RR 0.76) or major adverse cardiovascular events compared to clopidogrel in patients with chronic coronary syndrome undergoing percutaneous coronary intervention.
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