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Ticagrelor Versus Clopidogrel in Patients With Chronic Coronary Syndrome Undergoing Percutaneous Coronary

Johann Bill Pinedo-Avila1, Jessica Lucia Valera-Cabrera2, Ana Avalos-Rodríguez3

  • 1Unidad de Cuidados Intensivos de Neurocirugía del Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|September 9, 2025
PubMed

Insights

Ticagrelor and clopidogrel show similar efficacy for chronic coronary syndrome (CCS) patients undergoing percutaneous coronary intervention (PCI). Ticagrelor may increase chest pain, but other safety outcomes appear comparable.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Current guidelines recommend clopidogrel for chronic coronary syndrome (CCS) patients post-percutaneous coronary intervention (PCI).
  • Comparative efficacy and safety data between ticagrelor and clopidogrel in this population remain unclear.

Purpose of the Study:

  • To evaluate the efficacy and safety of ticagrelor compared to clopidogrel in patients with CCS undergoing PCI.
  • To synthesize evidence from randomized controlled trials (RCTs) to inform clinical practice.

Main Methods:

  • Systematic review and meta-analysis of parallel randomized controlled trials (RCTs) sourced from PubMed/MEDLINE, EMBASE, and CENTRAL databases up to February 15, 2025.
  • Included adults with CCS undergoing PCI, comparing ticagrelor maintenance therapy against clopidogrel.
  • Primary outcomes included mortality, myocardial infarction, quality of life, heart failure, stroke/transient ischemic attack (TIA), revascularization, and adverse events, assessed using the GRADE approach for certainty of evidence.

Main Results:

  • Nine RCTs involving 3370 patients were analyzed.
  • Ticagrelor demonstrated probable similar efficacy to clopidogrel regarding cardiovascular mortality, all-cause mortality, heart failure, stroke/TIA, and revascularization, though evidence for some outcomes was very uncertain.
  • Ticagrelor showed probable similar safety profiles for bleeding events but likely increased the risk of chest pain/tightness (7.5 per 100 patients).

Conclusions:

  • Ticagrelor exhibits comparable efficacy to clopidogrel for most cardiovascular outcomes in CCS patients undergoing PCI.
  • The safety profiles are largely similar, with a notable increase in the incidence of chest pain/tightness associated with ticagrelor.
  • Further research may be needed to clarify uncertainties regarding specific cardiovascular events and long-term outcomes.
Abstract

Keywords:
angioplasty, balloon, coronarychronic coronary syndromeclopidogrelcoronary artery diseaseplatelet aggregation inhibitorsticagrelor

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