Ticagrelor vs. clopidogrel and adverse events in patients with acute coronary syndrome undergoing PCI

Ticagrelor is the recommended P2Y12 platelet inhibitor for patients with acute coronary syndrome (ACS), but because this indication is largely based on the results of one large study, a closer look was warranted. A retrospective study subsequently asked whether ticagrelor generates better outcomes than clopidogrel among ACS patients who undergo percutaneous coronary intervention (PCI) in routine clinical practice. Researchers considered 31,290 propensity-matched pairs of patients in the United States and South Korea, specifically noting the incidence of ischemic and hemorrhagic events in each cohort. They calculated the 1-year risk of net adverse clinical events (NACE) with ticagrelor at 15.1%, which was not significantly different from the rate of 14.6% with clopidogrel. Although the risk of death for any reason was similar between groups, researchers did document markedly greater risk for hemorrhagic events and dyspnea in the ticagrelor recipients. Because the potential for unmeasured confounders cannot be ruled out, investigators recommend additional research to gauge the efficacy of ticagrelor compared with clopidogrel in this setting.