Ticagrelor Versus Clopidogrel in Patients With Chronic Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.

Current guidelines recommend clopidogrel in patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI), yet the comparative benefits are unclear. The aim of this study was to evaluate the efficacy and safety of ticagrelor versus clopidogrel in patients with CCS undergoing PCI. We searched PubMed/MEDLINE, EMBASE, CENTRAL databases from inception to February 15, 2025. We included parallel randomized controlled trials (RCTs) involving adults with CCS undergoing PCI, where the intervention group received ticagrelor as maintenance therapy and the control group received clopidogrel. Primary outcomes included all-cause or cardiovascular mortality, myocardial infarction, quality of life, heart failure, stroke/transient ischemic attack (TIA), revascularization, and adverse events. Study selection and data extraction were conducted independently. We determined the certainty of evidence using the GRADE approach. We included nine RCTs, with 3370 patients. Compared to clopidogrel, ticagrelor probably results in no important difference in cardiovascular mortality and hospital stay; may not have an important effect on stroke and/or TIA; and may not have an important effect on all-cause mortality, heart failure, and revascularization, but the evidence is very uncertain. Additionally, the evidence is very uncertain about the effect on myocardial infarction. Regarding safety outcomes, ticagrelor probably results in no important difference in major bleeding, minor bleeding, any bleeding, or dyspnea. However, it probably increases the risk of chest pain/tightness ( + 7.5 per 100; 95% CI: +1.4 to +21.7). In patients with CCS undergoing PCI, ticagrelor probably has a similar efficacy and safety to clopidogrel in most cardiovascular outcomes. However, it probably increases the risk of chest pain/tightness.