Editors, We read with great interest the article by Han et al. [1], which provided valuable insights into the long-term outcomes of ticagrelor versus clopidogrel in patients undergoing retrograde chronic total occlusion percutaneous coronary intervention (CTO-PCI). The study suggests that ticagrelor significantly reduced the rate of major adverse cardiovascular events, primarily driven by lower mortality rates. Although this well-designed retrospective cohort offers important clinical implications, several methodological aspects merit further consideration to strengthen the robustness of the conclusions.