Ticagrelor versus clopidogrel in Chinese patients with coronary artery disease: a retrospective real-world study

This study compares ticagrelor and clopidogrel on major adverse cardiovascular events (MACE) and bleeding risk in Chinese CAD patients. Conducted at the Chinese PLA General Hospital from June 2017 to October 2020, it involved patients on DAPT, divided into A + C (aspirin + clopidogrel) and A + T (aspirin + ticagrelor) groups. The primary endpoint was MACE, including all-cause mortality, non-fatal myocardial infarction, and stroke. The secondary endpoint was BARC type 2, 3, and 5 bleeding events. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) adjusted confounders. Weighted outcomes and Cox models assessed treatment and outcomes. Of 844 patients, 631 were in A + C (470 males, median age 65) and 213 in A + T (178 males, median age 60). Covariates balanced using IPTW or PSM showed no significant baseline differences (P > 0.05, SMD < 0.2). No significant differences in MACE or BARC type 3/5 bleeding were found between groups. However, the A + T group had a higher risk of BARC type 2 bleeding (HR: 4.16, 95% CI: 2.18-7.90). The incidence rates of MACE events were 2.38% (15/631) in the A + C group and 3.29% (7/213) in the A + T group. This study indicates ticagrelor and clopidogrel have similar MACE and BARC type 3/5 bleeding incidence, but ticagrelor shows higher BARC type 2 bleeding risk.