Ticagrelor versus clopidogrel in patients with chronic coronary syndrome undergoing percutaneous coronary intervention: A propensity score-matched analysis

Abstract

Aims This study aimed to evaluate the efficacy and safety of ticagrelor-based dual antiplatelet therapy (DAPT) compared to clopidogrel-based DAPT in patients with chronic coronary syndrome (CCS) undergoing elective percutaneous coronary intervention (PCI) in a real-world setting. Methods and results This was a retrospective, single-centre study including consecutive CCS patients discharged on DAPT after elective PCI between 2019 and 2022. Propensity score matching (PSM) was performed to account for confounding factors, including clinical, angiographic, and procedural variables. The primary endpoint was the incidence of major adverse cardiovascular events (MACE) at 1-year follow-up, defined as a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke. Secondary endpoints included the individual components of MACE and major bleeding, A total of 1236 patients were included, 731 treated with ticagrelor and 505 with clopidogrel. Before matching, ticagrelor prescription was associated with higher thrombotic risk and lower bleeding risk profile. PSM resulted in 351 pairs. Ticagrelor was associated with a lower 1-year incidence of MACE (2.3% vs. 6.6%; HR 0.34, 95% CI 0.15–0.76; p = 0.008) and all-cause mortality (2.3% vs. 5.1%; HR 0.43, 95% CI 0.19–0.99; p = 0.049). No significant differences were observed in non-fatal myocardial infarction, non-fatal stroke, or major bleeding. Conclusion In this cohort of patients with CCS undergoing PCI, ticagrelor was associated with a lower incidence of MACE at 1-year follow-up compared to clopidogrel, without an increase in major bleeding. Dedicated randomised controlled trials are needed to confirm these findings.