Introduction: This prospective, multicenter, randomized study was designed to analyze the benefits of
ticagrelor over
clopidogrel in reducing subclinical
stent thrombosis (ST) in patients with
coronary artery disease who underwent implantation of a second-generation
drug-eluting stent (DES).Methods: About 352 patients with single de novo
coronary stenosis were randomly assigne`d to either
clopidogrel group (
aspirin plus
clopidogrel) or
ticagrelor group (
aspirin plus
ticagrelor) after DES implantation for 1 year. Baseline clinical characteristics, blood chemistry markers, coronary artery angiography (CAG), and optical coherence tomography (OCT) were obtained during the index procedure. Data about clinic, CAG and OCT were also collected after 1 year follow-up. Intention-to-treat (ITT), per protocol set (PPS), and sensitivity analysis of subclinical ST were performed. Major factors associated with subclinical ST were analyzed by multivariable and univariable logistic regression models.Results: The incidence of subclinical ST in
ticagrelor group was significantly low as compared to
clopidogrel group (P < .05) at 1-year follow-up.
Ticagrelor use was an independent factor in reducing subclinical ST (P < .05). The percentage of endothelial coverage, neointimal
hyperplasia, malapposition, and edge dissection about
stents were not different between the two groups (P > .05).
Bleeding ratio was not markedly altered after
ticagrelor treatment (P > .05). Not any significant differences were detected with regard to baseline clinical characteristics, CAG results, and DES between
ticagrelor and
clopidogrel groups (P > .05).Conclusion: In patients who underwent a second-generation DES implantation, using
aspirin plus
ticagrelor was associated with a significant reduction in subclinical ST. (ClinicalTrials.gov. Number: NCT02140801).