Coronary disease & ACSRandomised controlled trial
Twice-Daily Clopidogrel vs Ticagrelor to Reduce Short-Term Major Adverse Cardiovascular Events After Primary Percutaneous Coronary Intervention
- Randomised controlled trial
- double-blind
- superiority
- single-centre
Authors' conclusion
Ticagrelor was not superior to twice-daily clopidogrel in reducing MACEs at 1 month after primary PCI, and bleeding rates were similar.
Study context
- Population
- Patients with STEMI within 24 hours of primary percutaneous coronary intervention (PCI), National Institute of Cardiovascular Diseases, Karachi, Pakistan
- Participants
- 2,201 patients
- Comparison
- Ticagrelor vs twice-daily clopidogrel
- Primary endpoint
- MACE:
- Death
- MI
- Stent thrombosis
- Stroke
- Target lesion revascularization
- Follow-up
- 1 month
Primary result
As reported in the abstract
MACE
Each group vs twice-daily clopidogrelHazard ratio (95% CI)P value
Ticagrelor
0.75(0.44–1.27)
P = 0.28Each group vs twice-daily clopidogrelAbsolute risk difference (95% CI)
Ticagrelor
−0.7%(−2.05 to 0.60)
Secondary outcomes
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| MACE at 7 days | 0.15 (0.04–0.5) | P = 0.002 | |
| MACE at 14 days | 0.46 (0.23–0.91) | P = 0.02 | |
| 0.050.21520Hazard ratio (log scale) |
Safety
| Outcome | Ticagrelor | Twice-daily clopidogrel | HR (95% CI) | |
|---|---|---|---|---|
| Clinically significant bleeding (BARC type 2, 3 or 5) | 0.5% | 0.4% | 1.50 (0.42–5.31) | |
| Major bleeding (BARC type 3 or 5) | 0.3% | 0.2% | 1.50 (0.25–8.97) | |
| 0.10.31310Hazard ratio (log scale) |
Original publication
Twice-Daily Clopidogrel vs Ticagrelor to Reduce Short-Term Major Adverse Cardiovascular Events After Primary Percutaneous Coronary Intervention. J Am Coll Cardiol. Published 30 August 2025. doi:10.1016/j.jacc.2025.08.041
Summarised from the published abstract; every number is checked against it