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.