Pandit Anil, Aryal Madan Raj, Aryal Pandit Aashrayata, Jalota Leena, Hakim Fayaz A, Mookadam Farouk, Lee Howard R, Tleyjeh Imad M
Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA.
EuroIntervention. 2014 Mar 20;9(11):1350-8. doi: 10.4244/EIJV9I11A226.
Cangrelor is a new antiplatelet agent that has been used in percutaneous coronary intervention (PCI) with mixed results. We aimed to review the evidence on the efficacy of cangrelor in comparison to clopidogrel in reducing ischaemic endpoints at 48 hours in patients undergoing PCI in large randomised trials.
In three large clinical trials involving 25,107 participants, the risk of the primary composite efficacy endpoint of death, MI and ischaemia-driven revascularisation at 48 hours, (pooled OR 0.94; 95% CI: 0.77-1.14, p=0.51, I2=68%), death from all cause (pooled OR 0.72, 95% CI: 0.36-1.43, p=0.34, I2=52%), myocardial infarction (pooled OR 0.94, 95% CI: 0.77-1.14, p=0.51, I2=68%) was not significantly different between cangrelor and clopidogrel. Likewise, severe or life-threatening bleeding was similar between cangrelor and clopidogrel (pooled OR 1.21, 95% CI: 0.70-2.12, p=0.50, I2=0%). The risk of stent thrombosis (pooled OR 0.59, 95% CI: 0.43-0.81, p=0.001, I2=0%), Q-wave myocardial infarction (pooled OR 0.53, 95% CI: 0.30-0.92, p=0.02, I2=0%) and ischaemia-driven revascularisation (pooled OR 0.71, 95% CI: 0.52-0.98, p=0.04, I2=0%) was lower in the cangrelor group.
Based on this meta-analysis, we did not find any difference in the risk of the primary composite efficacy endpoint of all-cause death, ischaemia-driven revascularisation, and myocardial infarction at 48hours between cangrelor and clopidogrel use. Given that cangrelor was associated with a lower risk of stent thrombosis, ischaemia-driven revascularisation and Q-wave myocardial infarction compared to clopidogrel, cangrelor can be considered as a suitable alternative during PCI.
坎格雷洛是一种新型抗血小板药物，已用于经皮冠状动脉介入治疗（PCI），但结果不一。我们旨在回顾大型随机试验中接受PCI的患者使用坎格雷洛与氯吡格雷相比在48小时内降低缺血性终点事件疗效的证据。
在三项涉及25107名参与者的大型临床试验中，坎格雷洛组和氯吡格雷组在48小时时主要复合疗效终点（死亡、心肌梗死和缺血驱动的血运重建）的风险（合并OR 0.94；95%CI：0.77 - 1.14，p = 0.51，I² = 68%）、全因死亡（合并OR 0.72，95%CI：0.36 - 1.43，p = 0.34，I² = 52%）、心肌梗死（合并OR 0.94，95%CI：0.77 - 1.14，p = 0.51，I² = 68%）无显著差异。同样，坎格雷洛组和氯吡格雷组严重或危及生命的出血情况相似（合并OR 1.21，95%CI：0.70 - 2.12，p = 0.50，I² = 0%）。坎格雷洛组支架血栓形成风险（合并OR 0.59，95%CI：0.43 - 0.81，p = 0.001，I² = 0%）、Q波心肌梗死风险（合并OR 0.53，95%CI：0.30 - 0.92，p = 0.02，I² = 0%）和缺血驱动的血运重建风险（合并OR 0.71，95%CI：0.52 - 0.98，p = 0.04，I² = 0%）较低。
基于这项荟萃分析，我们发现使用坎格雷洛和氯吡格雷在48小时时全因死亡、缺血驱动的血运重建和心肌梗死的主要复合疗效终点风险没有差异。鉴于与氯吡格雷相比，坎格雷洛与较低的支架血栓形成、缺血驱动的血运重建和Q波心肌梗死风险相关，在PCI期间可将坎格雷洛视为合适的替代药物。
