Serebruany V L, Pershukov I V
Johns Hopkins University, Maryland, USA; FSBI Educational Scientific Medical Centre of the General Management Department of the President of RF, ul. Marshala Timoshenko 21, 121359 Moscow, Russia.
Kardiologiia. 2013;53(7):70-7.
The analysis of the evidence that formed the basis for the current guidelines of the European Society of Cardiology (ESC) on oral therapy by antithrombotic drugs for acute coronary syndromes (ACS), and a comparison with the U.S. guidelines. The ESC guidelines, published during 2011-2012, declared the superiority of prasugrel and ticagrelor over clopidogrel in patients with ACS without ST elevation and myocardial infarction (MI) with ST elevation. These guidelines are based in each case on a subgroup analysis of a single study using either prasugrel (TRITON), or ticagrelor (PLATO). In contrast, the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines, published in 2012-2013, are more balanced, conservative and present evidence-based outlook, suggesting no proven extra benefit of one P2Y12 antagonist over the other(s). The ESC guidelines regarding the findings of the superiority of prasugrel or ticagrelor over clopidogrel are overly optimistic and not always evidence-based. A small frequency of clinical use of prasugrel and ticagrelor in the world in general and Europe in particular, suggests a discrepancy between the traditionally appointed treatment and published ESC guidelines.
对构成欧洲心脏病学会（ESC）急性冠状动脉综合征（ACS）抗血栓药物口服治疗现行指南基础的证据进行分析，并与美国指南进行比较。2011 - 2012年期间发布的ESC指南宣称，在非ST段抬高型ACS患者以及ST段抬高型心肌梗死（MI）患者中，普拉格雷和替格瑞洛优于氯吡格雷。这些指南在每种情况下均基于对使用普拉格雷（TRITON）或替格瑞洛（PLATO）的单一研究进行的亚组分析。相比之下，2012 - 2013年发布的美国心脏病学会（ACC）和美国心脏协会（AHA）指南更为平衡、保守且呈现出基于证据的观点，表明没有证据证明一种P2Y12拮抗剂相对于其他拮抗剂有额外益处。ESC关于普拉格雷或替格瑞洛优于氯吡格雷这一结果的指南过于乐观，且并非总是基于证据。总体而言，全球尤其是欧洲普拉格雷和替格瑞洛的临床使用频率较低，这表明传统指定治疗与发布的ESC指南之间存在差异。
