Comparisons between ticagrelor and clopidogrel following percutaneous coronary intervention in patients with acute
Zhong-Guo Fan1, Wen-Ling Zhang2, Bing Xu1
1Department of Cardiology, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yangzhou, Jiangsu, China, yzhshys@163.com.
Insights
Ticagrelor use after percutaneous coronary intervention for acute coronary syndrome patients reduced cardiovascular death and stent thrombosis. However, this dual-antiplatelet therapy increased bleeding risk, necessitating further research.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Efficacy and safety of ticagrelor post-percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) patients require clarification.
- Dual-antiplatelet therapy (DAPT) is standard care, but optimal agent selection is debated.
Purpose of the Study:
- To evaluate clinical outcomes of ticagrelor as part of DAPT in ACS patients undergoing PCI.
- To assess the impact of ticagrelor on major adverse cardiovascular and cerebrovascular events (MACCE), stent thrombosis (ST), and bleeding risk.
Main Methods:
- A systematic review and meta-analysis of 11 clinical trials (6 randomized, 5 observational) was conducted.
- Databases searched include PubMed, MEDLINE, and Embase.
- Primary endpoint: MACCE (cardiovascular death, myocardial infarction, stroke). Secondary endpoint: ST. Safety endpoint: Bleeding risk.
Main Results:
- Ticagrelor showed a trend towards reduced MACCE (OR 0.83, P=0.091), driven by a significant reduction in cardiovascular death (OR 0.78, P<0.001).
- The incidence of ST was significantly lower in the ticagrelor group compared to clopidogrel (OR 0.74, P=0.009).
- However, ticagrelor use was associated with a significant increase in both major and minor bleeding events.
Conclusions:
- Ticagrelor, as part of DAPT post-PCI, effectively reduces cardiovascular death and ST in ACS patients.
- The benefit is counterbalanced by an increased risk of bleeding.
- Further large-scale randomized trials are needed to guide clinical practice.
Background:
The efficacy and safety of ticagrelor following percutaneous coronary intervention for patients with acute coronary syndrome remains unclear. This study sought to evaluate clinical outcomes of ticagrelor as part of dual-antiplatelet treatment for these patients.
Methods:
PubMed, MEDLINE, Embase, and other Internet sources were searched for eligible citations. The primary end point was major adverse cardiovascular and cerebrovascular events, consisting of cardiovascular death, myocardial infarction, and stroke. The secondary end point was the occurrence of definite/probable stent thrombosis (ST). The risk of bleeding was chosen to be the safety end point.
Results:
Eleven clinical trials - six randomized trials and five observational trials - were finally analyzed. A tendency toward reduction in the risk of major adverse cardiovascular and cerebrovascular events was observed only with respect to ticagrelor (OR 0.83, 95% CI 0.66-1.03; P=0.091), which might have resulted from the lower risk of cardiovascular death (OR 0.78, 95% CI 0.68-0.89; P<0.001). The overall incidence of ST differed significantly between the ticagrelor group and the clopidogrel group (OR 0.74, 95% CI 0.59-0.93; P=0.009), but the risk of bleeding, regardless of major or minor bleeding, increased significantly.
Conclusion:
As part of dual-antiplatelet treatment following percutaneous coronary intervention, ticagrelor significantly reduced the risk of cardiovascular death and ST in acute coronary syndrome patients, but at the cost of bleeding. More powerful relevant randomized trials are still warranted to guide clinical decision-making.
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