Pharmacology and clinical outcomes of ticagrelor in acute coronary syndrome and post-myocardial infarction patients: A meta-analysis

Ticagrelor is a potent antiplatelet drug that emerged as an alternative to clopidogrel in the management of patients with acute coronary syndrome (ACS) and post-myocardial infarction (post-MI). This meta-analysis aims to comprehensively assess the safety and efficacy of ticagrelor compared to clopidogrel in this patient population. We systematically searched multiple databases and included eight randomized controlled trials (RCTs) comparing ticagrelor and clopidogrel in ACS and post-MI patients undergoing PCI. The primary efficacy endpoints were stent thrombosis and revascularization, while the primary safety endpoints were major adverse cardiovascular events (MACE) and mortality. Ticagrelor significantly reduced stent thrombosis compared to clopidogrel (OR 0.71, 95 % CI 0.53–0.94, I² = 23 %) and a non-significant trends toward reduced revascularization (OR 0.74, 95 % CI 0.45–1.21, I² = 61 %) and MACE (OR 0.85, 95 % CI 0.69–1.04, I² = 67 %), limited by moderate to high heterogeneity. Conversely, ticagrelor was associated with a clinically meaningful reduction in mortality compared to clopidogrel (OR 0.85, 95 % CI 0.75–0.95, I² = 0 %). This meta-analysis suggests that ticagrelor is a more effective option than clopidogrel in preventing stent thrombosis and demonstrates a significant reduction in mortality in patients with ACS and post-MI undergoing PCI. While a non-significant trend towards lower revascularization and MACE was observed with ticagrelor, high heterogeneity and a lack of statistical significance for these outcomes preclude definitive conclusions. Overall, ticagrelor's consistent benefits in preventing stent thrombosis and reducing mortality support its consideration as a preferred option, alongside individualized treatment decisions that account for patient-specific factors, risk profiles, and clinical outcomes.