Ticagrelor versus Clopidogrel in Complex Percutaneous Coronary Intervention in terms of Mortality and Stent Thrombosis

Objective: To compare the effects of ticagrelor and clopidogrel on major adverse cardiovascular events (MACE), 30 day mortality, and stent thrombosis in patients with ST-elevation myocardial infarction (STEMI) undergoing complex percutaneous coronary intervention (PCI). Methodology: This quasi-experimental study was conducted at the Rawalpindi Institute of Cardiology, Rawalpindi in 3 months from June to August 2025 after ethical approval. After obtaining informed written consent, 376 patients with STEMI treated with complex PCI were included by non-probability convenience sampling technique. The patients were assigned to two groups: Group A received aspirin & clopidogrel, whereas group B received aspirin and ticagrelor. The outcomes assessed were MACE, 30 day mortality, and stent thrombosis. Follow-up was done till 1 month. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 25. Results: Bifurcation stenting was present in 80(42.6%) patients in clopidogrel group, while it was seen in 46(24.5%) patients in ticagrelor group. The left main PCI was also more prevalent in the ticagrelor group [81(43.1%)]. The thrombolysis in myocardial infarction (TIMI) 3 flow was restored in 53.7% versus 30.3% of the patients taking ticagrelor and clopidogrel, respectively. Stent thrombosis and MACE were significantly higher in the clopidogrel group (8.5% versus 2.7%) and (19.1% versus 11.2%), respectively. In contrast, no substantial difference was noted regarding 30 day mortality (9% vs. 8%) between the two groups. Conclusion: Ticagrelor is associated with improved post-PCI TIMI flow, lower incidence of MACE and stent thrombosis in STEMI patients who underwent complex PCI as compared to clopidogrel. However, 30 day mortality is not significantly different in the two groups.