Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome: A meta-analysis

Meijiao He; Yanxiang Zang; Danghui Sun; Jianqiang Li; Guangzhong Liu; Jing Shi; Yue Li

doi:10.2478/fzm-2022-0004

Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome: A meta-analysis

doi: 10.2478/fzm-2022-0004

Meijiao He^{1, #},
Yanxiang Zang^{1, #},
Danghui Sun^{1, #},
Jianqiang Li¹,
Guangzhong Liu¹,
Jing Shi¹,
Yue Li^{1, 2, 3
, ,}

1.
Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
2.
Institute of Metabolic Disease, Heilongjiang Academy of Medical Science, Harbin 150001, China
3.
Heilongjiang Key Laboratory for Metabolic Disorder & Cancer Related Cardiovascular Diseases, Harbin 150081, China

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Corresponding author: Yue Li, E-mail: ly99ly@vip.163.com

摘要

Abstract: Objective There exist conflicting data on the efficacy and safety of ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome (ACS). We performed a meta-analysis to evaluate whether ticagrelor or clopidogrel produces better outcomes for East Asian patients with ACS. Methods We searched for randomized controlled trials reporting associations between ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome in PubMed, EMBASE, web of science and Cochrane central register of controlled trials. Results Ten studies involving 3 715 participants were qualified for our analysis. The major adverse cardiovascular events (MACE) were significantly decreased in patients with ticagrelor treatment compared to those with clopidogrel (risk ratio [RR]: 0.61; 95% confidence interval [CI]: 0.38-0.98; P = 0.042). There was no significant difference in all-cause death (RR: 0.89; 95% CI: 0.61-1.29; P = 0.540), cardiovascular death (RR: 0.86; 95% CI: 0.58-1.27; P = 0.451), myocardial infarction (RR: 0.91; 95% CI: 0.65-1.27; P = 0.575) and stroke (RR: 0.77; 95% CI: 0.44-1.36; P = 0.372) between ticagrelor and clopidogrel. Ticagrelor was associated with a significantly higher risk of bleeding compared to clopidogrel (RR: 1.71; 95% CI: 1.37-2.13; P = 0.000). Conclusion The present meta-analysis demonstrates that ticagrelor reduced the incidence of MACE in ACS patients from East Asia compared with clopidogrel. However, it increased the risk of bleeding.
- ticagrelor /
- clopidogrel /
- acute coronary syndrome /
- Eastern Asia /
- meta-analysis

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Figure 1. Flowchart of study screening

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Figure 2. The quality assessment of the study

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Figure 3. Forest plots of major adverse cardiovascular events (MACE) between ticagrelor and clopidogrel

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Figure 4. Forest plots of A (All-cause death), B (Cardiovascular death), C (myocardial infarction), D (Stroke) between ticagrelor and clopidogrel

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Figure 5. Forest plots of A (Bleeding), B (Major bleeding), C (Minor bleeding) between ticagrelor and clopidogrel

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Figure 6. Publication bias and sensitivity analysis. Forest plots of MACE in the Chinese population

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Table 1. Baseline characteristics of included studies

References	Country	Follow-up(months)	Sample size(n)		Age(years)		Male(n)		Hypertension(%)		Diabetes(%)
References	Country	Follow-up(months)	Ticagrelor	Clopidogrel	Ticagrelor	Clopidogrel	Ticagrelor	Clopidogrel	Ticagrelor	Clopidogrel	Ticagrelor	Clopidogrel
Goto S et al., 2015^[7]	China, South Korea and Japan	12	401	400	67±12	66±11	306	307	76.1	72.5	38.4	31.0
Kang HJ et al., 2015^[9]	China and South Korea	12	278	273	NA	NA	NA	NA	NA	NA	NA	NA
Xia JG et al., 2015^[19]	China	6	48	48	53.7±10.3	54.6±9.8	36	38	62.5	64.6	50	45.8
Wang HD et al., 2016^[11]	China	12	100	100	NA	NA	69	66	79	82	42	39
Tang XY et al., 2016^[20]	China	6	200	200	64.36±11.41	64.18±11.09	142	146	61	58	29	21
Ren Q et al., 2016^[21]	China	12	149	151	56±9.2	55±8.0	102	106	NA	NA	NA	NA
Lu YJ et al., 2016^[22]	China	12	95	108	59.25±9.63	59.63±9.88	52	60	34.7	38.9	25.3	29.6
Wu HB et al., 2018^[12]	China	12	124	120	58.976±10.187	61.058±11.600	98	94	51.6	57.5	25.8	20.8
Yang B et al., 2018^[13]	China	6	60	60	59.6±15.7	58.7±13.5	35	38	NA	NA	NA	NA
Park DW et al., 2019^[23]	South Korea	12	400	400	62.5±11.3	62.3±11.5	297	302	55.8	48.2	29.0	25.0

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