Efficacy and Safety of Ticagrelor in East Asian Patients with Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Background: Although current guidelines recommend ticagrelor to clopidogrel for patients with acute coronary syndrome, its benefit and risk are unclear for East Asians. This meta-analysis was performed to assess the efficacy and safety of ticagrelor in East Asian patients with acute coronary syndrome. Methods: Medline, EMBASE, and Cochrane Databases were searched from inception to July, 2021, for randomized controlled trials comparing ticagrelor with clopidogrel in East Asian patients with acute coronary syndrome. Major adverse cardiovascular events and bleeding events were assessed by using Mantel-Haenszel-pooled risk ratio and 95% confidence interval. Results: Five randomized controlled trials identified 2752 patients with acute coronary syndrome. Compared with clopidogrel, ticagrelor had no statistical difference of major adverse cardiovascular events (RR 0.87; 95% CI 0.52-1.45; P =.58), all cause death (RR 0.90, 95% CI 0.62-1.32; P =.60), cardiovascular death (RR 0.90, 95% CI 0.47-1.72; P =.74), myocardial infarction (RR 0.91, 95% CI 0.52-1.58; P =.73), and stroke (RR 0.87, 95% CI 0.48-1.57; P =.64). Despite ticagrelor did not increase the incidence of fatal bleeding (RR 2.49, 95% CI 0.79-7.87; P = 0.12), the risks of all bleeding (RR 1.71, 95% CI 1.36-2.16; P <.00001), major bleeding (RR 1.51, 95% CI 1.12-2.04; P =.007), non-coronary artery bypass grafting major bleeding (RR 1.83, 95% CI 1.23-2.71; P =.003), and minor bleeding (RR 1.92, 95% CI 1.40-2.64; P <.0001) were significantly higher. Conclusions: Although there was no significant difference in the incidence of fatal bleeding, ticagrelor displayed similar efficacy and dramatically increased the risk of other bleeding events.