A Comparative Study on Ticagrelor and Clopidogrel in Patients With Acute Coronary Syndrome Treated With Primary Percutaneous Coronary Intervention

Abstract This study was conducted to compare the efficacy and safety of ticagrelor and clopidogrel in patients with acute coronary syndrome (ACS) treated with primary percutaneous coronary intervention (PPCI). A total of 3528 consecutive patients with ACS treated with PPCI were divided into the ticagrelor and clopidogrel groups based on their dual antiplatelet therapy regimen at hospital discharge. Patient follow‐up visits were completed 1, 6, and 12 months after PPCI treatment. Major adverse cardiac events (MACEs) and Bleeding Academic Research Consortium (BARC) bleeding events were assessed in both groups. In total, 2501 cases were included in the ticagrelor group, and 817 cases were included in the clopidogrel group. The incidence of MACEs was lower in the ticagrelor group than in the clopidogrel group ( P < .05). The ticagrelor group had lower incidence of all‐cause death and cardiac death compared with the clopidogrel group, and the difference was significant ( P < .05). The incidences of study end points, including recurrent myocardial infarction and repeat revascularization, were not significantly different between the groups ( P > .05). The incidences of BARC total and major bleeding events were not significantly different between the groups ( P > .05). However, the incidences of BARC type 1 and 2 bleeding events were lower in the ticagrelor group than in the clopidogrel group ( P < .05). The multivariate Cox regression analysis suggested that ticagrelor could decrease all‐cause death compared with clopidogrel ( P = .021). In patients with ACS treated with PPCI, ticagrelor could significantly reduce the risk of MACEs compared with clopidogrel, without increasing the risk of bleeding.