Ticagrelor Versus Clopidogrel in East Asian Patients with Acute Coronary Syndrome: A Meta-Analysis

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 3715 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.