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Is ticagrelor really superior to clopidogrel in ACS patients who underwent PCI?

Read by Konstantinos Toutouzas

Main conclusions

Among patients with ACS who underwent PCI, ticagrelor, compared with clopidogrel, was not associated with less adverse cardiovascular events at 12 months and showed no significant difference in all -cause mortality or ischemic events. Haemorrhagic events and dyspnoea were more frequent in the ticagrelor group.

Type of study

Retrospective cohort study of patients with ACS who underwent PCI and received ticagrelor or clopidogrel, using two United States and one nationwide South Korean databases. ( November 2011 to March 2019). Patients were matched using a large-scale propensity score algorithm.

Main message for clinical practice

These results challenge the conventional wisdom that ticagrelor is more effective than clopidogrel in DAPT opening the way into a consideration of atailored or a de-escalated approach for ACS patients who underwent PCI

Main limitations

Retrospective and observational study with a possibility of unmeasured confounding variables: further confirmation necessary.


You SC et al. Association of Ticagrelor vs Clopidogrel With Net Adverse Clinical Events in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. JAMA. 2020 Oct 27;324(16):1640-1650.