Ticagrelor versus clopidogrel in patients with chronic coronary syndrome undergoing percutaneous coronary...

Area of Science:

• Cardiology
• Pharmacology
• Interventional Cardiology

Background:

• Dual antiplatelet therapy (DAPT) is crucial for patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI).
• Ticagrelor and clopidogrel are commonly used P2Y12 inhibitors in DAPT regimens.
• Real-world data is needed to compare their effectiveness and safety in diverse patient populations.

Purpose of the Study:

• To compare the efficacy and safety of ticagrelor-based DAPT versus clopidogrel-based DAPT.
• To evaluate outcomes in patients with CCS undergoing elective PCI in a real-world setting.
• To assess the incidence of major adverse cardiovascular events (MACE) and major bleeding.

Main Methods:

• Retrospective, single-center study of CCS patients discharged on DAPT after elective PCI (2019-2022).
• Propensity score matching (PSM) used to balance baseline characteristics.
• Primary endpoint: 1-year incidence of MACE (all-cause death, non-fatal MI, non-fatal stroke).
• Secondary endpoints: individual MACE components and major bleeding.

Main Results:

• After PSM (351 pairs), ticagrelor was associated with significantly lower 1-year MACE incidence (2.3% vs. 6.6%; HR 0.34).
• Ticagrelor also showed a reduction in all-cause mortality (2.3% vs. 5.1%; HR 0.43).
• No significant differences in non-fatal myocardial infarction, non-fatal stroke, or major bleeding were observed between groups.

Conclusions:

• Ticagrelor-based DAPT demonstrated a favorable 1-year outcome profile compared to clopidogrel-based DAPT in CCS patients undergoing PCI.
• The observed benefit was achieved without a significant increase in major bleeding events.
• Further confirmation through randomized controlled trials is warranted.