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

## TL;DR

This study compares ticagrelor and clopidogrel in patients with chronic coronary syndrome undergoing heart procedures, finding ticagrelor may reduce stent issues without significant safety risks.

## Contribution

The study provides a meta-analysis of ticagrelor versus clopidogrel in chronic coronary syndrome patients post-PCI, focusing on stent thrombosis and bleeding risks.

## Key findings

- Ticagrelor significantly reduced stent thrombosis compared to clopidogrel.
- No significant differences were observed in mortality, MACE, or MI between the two drugs.
- Bleeding risk was numerically higher with ticagrelor but not statistically significant.

## Abstract

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.