Coronary disease & ACS

Aspirin vs clopidogrel in chronic coronary syndromes: a meta-analysis of ethnic differences

Eur Heart JPublished Systematic review and meta-analysis of randomised trials

Pooled result · MACEResult — go to the resultIncidence rate ratio 0.83 95% CI 0.69–0.99

Authors' conclusion

In patients with CCS, the overall body of evidence suggests improved outcomes with clopidogrel compared with aspirin, without an apparent effect on mortality.

Study context

Population
Patients with chronic coronary syndromes (CCS)
Participants
30,165 patients7 randomized controlled trials (RCTs)
Comparison
Clopidogrel vs aspirin for secondary prevention
Outcome
Trial-defined MACE
Follow-up
Median 36.0 months
Methodological detailsprespecified subgroup interaction by ethnicity, trial sequential analysis
  • Prespecified subgroup interaction by ethnicity
  • Trial sequential analysis

Pooled result

MACE

Incidence rate ratio

0.83

95% CI 0.69–0.99

Clopidogrelvs Aspirin
IRR 0.83 (95% CI 0.69–0.99)

As reported in the abstract

Further pooled results

Major adverse cardiovascular events (MACE) by ethnicity (prespecified subgroup)

East Asians: IRR
0.76 (95% CI 0.59-0.98)
Non-East Asians: IRR
1.00 (95% CI 0.74-1.36)
No significant benefits in non-East Asian patients
  • Interaction P = 0.010

Mortality by ethnicity (subgroup)

Significant interaction by ethnicity
Pint = 0.014

Major bleeding, MI, mortality

No differences between groups

Safety

Major bleeding

No difference between groups

Original publication

Aspirin vs clopidogrel in chronic coronary syndromes: a meta-analysis of ethnic differences. Eur Heart J. Published 19 May 2026. doi:10.1093/eurheartj/ehag351

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