Comparison of Ticagrelor Versus Clopidogrel in Preventing Early Stent Thrombosis after Primary PCI

Abstract

Background: Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is a potentially life-threatening complication that occurs early after the procedure. Ticagrelor is an agent that is more effective and faster-acting at inhibiting platelets than clopidogrel, and may be more protective against thrombosis.
Objective: To compare ticagrelor and clopidogrel in preventing early stent thrombosis after primary PCI in patients with STEMI.
Methods: This was a comparative observational study conducted at Punjab Institute of Cardiology, Lahore, from February 2023 to August 2023. Patients who underwent primary PCI with stent implantation were consecutively sampled to enroll 93 patients. Dual antiplatelet therapy consisted of ticagrelor (n=47) or clopidogrel (n=46). Participants were observed for 30 days for events of early stent thrombosis and for other clinical outcomes. The data were analysed using SPSS 26.
Results: The incidence of early stent thrombosis was 2 (4.3%) in the ticagrelor group and 7 (15.2%) in the clopidogrel group (p=0.091). Numerically fewer patients had recurrent myocardial infarction, target-vessel revascularization, rehospitalization, or death with ticagrelor. Neither group had high rates of major bleeding. On multivariable analysis, early stent thrombosis was independently predicted by Killip class III–IV (p=0.049).
Conclusion: Ticagrelor was not statistically significantly associated with reduced early stent thrombosis compared to clopidogrel after primary PCI, but the number of such occurrences was lower. The findings are supported by the need for larger randomized studies.
Keywords: Ticagrelor, Clopidogrel, Stent Thrombosis, Primary PCI, STEMI.