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

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. 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. 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. Evaluar la eficacia y seguridad de la doble terapia antiplaquetaria (DAPT) basada en ticagrelor frente a clopidogrel en pacientes con síndrome coronario crónico (SCC) sometidos a intervención coronaria percutánea (ICP) electiva en vida real. Estudio retrospectivo y unicéntrico que incluyó pacientes consecutivos con SCC, dados de alta con DAPT tras ICP electiva entre 2019 y 2022. Se realizó un emparejamiento por puntuación de propensión (PSM) para ajustar factores de confusión. El objetivo primario fue la incidencia de eventos cardiovasculares adversos mayores (MACE) a un año, compuesto por mortalidad por cualquier causa, infarto de miocardio (IAM) no fatal y accidente cerebrovascular no fatal. Los objetivos secundarios incluyeron los componentes individuales de MACE y el sangrado mayor. Se incluyeron 1,236 pacientes (731 con ticagrelor y 505 con clopidogrel). Antes del emparejamiento, ticagrelor se asoció con mayor riesgo trombótico y menor riesgo de sangrado. Tras el PSM (351 pares), ticagrelor mostró una menor incidencia de MACE a un año (2.3% vs. 6.6%; HR 0.34, IC 95% 0.15-0.76; p = 0.008) y menor mortalidad por cualquier causa (2.3% vs. 5.1%; HR 0.43, IC 95% 0.19-0.99; p = 0.049), sin diferencias significativas en IAM no fatal, accidente cerebrovascular no fatal o sangrado mayor. En esta cohorte de pacientes con SCC sometidos a ICP, ticagrelor se asoció con una menor incidencia de MACE a un año de seguimiento en comparación con clopidogrel, sin un aumento en el sangrado mayor. Se requieren ensayos controlados aleatorizados específicos para confirmar estos hallazgos.