Ticagrelor versus clopidogrel in STEMI post-PCI: A mixed-design meta-analysis of efficacy and safety.
ST-segment elevation myocardial infarction (STEMI) requires primary percutaneous coronary intervention (PCI) and dual antiplatelet therapy with aspirin and a purinergic receptor Y12 inhibitor to reduce thrombotic risks. Ticagrelor, a potent purinergic receptor Y12 inhibitor, offers faster and stronger platelet inhibition than clopidogrel, but evidence on its efficacy and safety in STEMI patients post-PCI is conflicting. This study aims to compare the efficacy and safety of ticagrelor versus clopidogrel in STEMI patients undergoing primary PCI.
This systematic review and meta-analysis, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, searched PubMed, Embase, ScienceDirect, and ClinicalTrials.gov up to July 2025. Included were randomized controlled trials and observational studies comparing ticagrelor to clopidogrel in adult STEMI patients post-PCI, reporting cardiovascular outcomes. Data were pooled using odds ratios (ORs) with 95% confidence intervals (CIs) via random-effects models.
Eight studies (5 randomized controlled trials, 3 observational; n = 31,729) showed ticagrelor significantly reduced all-cause mortality (OR = 0.64, 95% CI = 0.47-0.88; P = .006), cardiovascular mortality (OR = 0.68, 95% CI = 0.60-0.93; P = .01), major adverse cardiovascular events (OR = 0.71, 95% CI = 0.60-0.84; P = .01), myocardial infarction (OR = 0.71, 95% CI = 0.61-0.83; P < .00001), stent thrombosis (OR = 0.66, 95% CI = 0.55-0.79; P < .00001), and major bleeding (OR = 0.87, 95% CI = 0.78-0.97; P = .01), but increased target vessel revascularization (OR = 1.30, 95% CI = 1.05-1.61; P = .02). No significant difference was observed in stroke risk (OR = 1.16, 95% CI = 0.89-1.52; P = .28).
Ticagrelor outperforms clopidogrel in STEMI post-PCI, reducing key adverse outcomes, though higher target vessel revascularization risk warrants caution.
This systematic review and meta-analysis, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, searched PubMed, Embase, ScienceDirect, and ClinicalTrials.gov up to July 2025. Included were randomized controlled trials and observational studies comparing ticagrelor to clopidogrel in adult STEMI patients post-PCI, reporting cardiovascular outcomes. Data were pooled using odds ratios (ORs) with 95% confidence intervals (CIs) via random-effects models.
Eight studies (5 randomized controlled trials, 3 observational; n = 31,729) showed ticagrelor significantly reduced all-cause mortality (OR = 0.64, 95% CI = 0.47-0.88; P = .006), cardiovascular mortality (OR = 0.68, 95% CI = 0.60-0.93; P = .01), major adverse cardiovascular events (OR = 0.71, 95% CI = 0.60-0.84; P = .01), myocardial infarction (OR = 0.71, 95% CI = 0.61-0.83; P < .00001), stent thrombosis (OR = 0.66, 95% CI = 0.55-0.79; P < .00001), and major bleeding (OR = 0.87, 95% CI = 0.78-0.97; P = .01), but increased target vessel revascularization (OR = 1.30, 95% CI = 1.05-1.61; P = .02). No significant difference was observed in stroke risk (OR = 1.16, 95% CI = 0.89-1.52; P = .28).
Ticagrelor outperforms clopidogrel in STEMI post-PCI, reducing key adverse outcomes, though higher target vessel revascularization risk warrants caution.
Authors
Shahid Shahid, Sajjad Sajjad, Patel Patel, Tarar Tarar, Rasheed Rasheed, Jaffar Jaffar, Rana Rana, Abbas Abbas, Rasheed Rasheed, Shahid Shahid, Khawar Khawar, Shenawa Shenawa
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