Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, 1900 W Harrison Street, Chicago, IL, USA.
Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Am J Cardiovasc Drugs. 2019 Oct;19(5):465-476. doi: 10.1007/s40256-019-00337-5.
The newer P2Y inhibitors have better efficacy than clopidogrel. However, whether ticagrelor or prasugrel have a better comparative safety and efficacy profile, especially in the long-term, remains inconclusive.
We compared prasugrel and ticagrelor in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
MEDLINE and the Cochrane library were queried for randomized controlled trials (RCTs) or observational studies comparing prasugrel with ticagrelor in patients with ACS undergoing PCI. Random-effects pooling was used to calculate odds ratios (ORs) with 95% confidence intervals (CI). Analyses were stratified by duration of follow-up (short term [≤ 3 months] and long term [≥ 1 year]) and study design.
In total, 14 studies (six RCTs, eight observational studies), including 40,188 patients, met eligibility criteria. Pooled analysis did not indicate that prasugrel significantly decreased all-cause mortality compared with ticagrelor in the short term (OR 0.49; 95% CI 0.20-1.20; p = 0.11) or long term (OR 0.74; 95% CI 0.48-1.15; p = 0.38). Pooled observational studies showed significantly lower long-term all-cause mortality (OR 0.63; 95% CI 0.43-0.92; p = 0.02) and short-term stent thrombosis (OR 0.46; 95% CI 0.28-0.75; p = 0.002) with prasugrel. No significant difference was observed in the risk of nonfatal myocardial infarction, ischemic stroke, bleeding, or repeat revascularization between the two groups. Results remained similar after stratification according to follow-up and study design.
The present analysis suggests that prasugrel might have a better efficacy profile than ticagrelor in patients with ACS undergoing PCI. However, this advantage was only seen in pooled observational studies and is likely to be affected by selection bias.
新型 P2Y 抑制剂的疗效优于氯吡格雷。然而，替格瑞洛或普拉格雷在长期安全性和疗效方面是否具有更好的比较优势，目前尚无定论。
我们比较了急性冠状动脉综合征（ACS）行经皮冠状动脉介入治疗（PCI）的患者中普拉格雷和替格瑞洛的疗效。
在 MEDLINE 和 Cochrane 图书馆中检索了比较 ACS 患者行经皮冠状动脉介入治疗中普拉格雷与替格瑞洛的随机对照试验（RCT）或观察性研究。采用随机效应模型计算优势比（OR）及其 95%置信区间（CI）。根据随访时间（短期[≤3 个月]和长期[≥1 年]）和研究设计进行分层分析。
共有 14 项研究（6 项 RCT，8 项观察性研究），纳入 40188 例患者，符合纳入标准。汇总分析结果显示，短期治疗时，与替格瑞洛相比，普拉格雷并未显著降低全因死亡率（OR 0.49；95% CI 0.20-1.20；p=0.11）；长期治疗时，普拉格雷也未显著降低全因死亡率（OR 0.74；95% CI 0.48-1.15；p=0.38）。汇总的观察性研究显示，普拉格雷组患者长期全因死亡率（OR 0.63；95% CI 0.43-0.92；p=0.02）和短期支架血栓形成（OR 0.46；95% CI 0.28-0.75；p=0.002）显著降低。两组间非致死性心肌梗死、缺血性卒中和出血或再次血运重建的风险无显著差异。根据随访时间和研究设计进行分层后，结果仍相似。
本分析表明，ACS 行经皮冠状动脉介入治疗的患者中，普拉格雷的疗效可能优于替格瑞洛。然而，这一优势仅见于汇总的观察性研究，且可能受到选择偏倚的影响。
