The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China.
The Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi Province, China.
Cardiovasc Drugs Ther. 2020 Apr;34(2):199-208. doi: 10.1007/s10557-020-06940-y.
Although current guidelines recommend ticagrelor in addition to aspirin as the antiplatelet strategy for medically managed acute coronary syndrome (MMACS) patients, clinical evidence specific to this special population is lacking. Whether potent oral P2Y inhibitors should be used in MMACS patients is still under debate.
We conducted a comprehensive search in PubMed, Embase, Web of Science, and Cochrane Library to identify studies exploring the efficacy or safety of ticagrelor and prasugrel versus clopidogrel or placebo in MMACS patients. The primary efficacy endpoint was major adverse cardiovascular events (MACE) defined by each study, and the safety endpoint was TIMI non-CABG major bleeding.
A total of 6102 records were screened, and 4 studies including 46,346 patients were finally included. The use of potent oral P2Y inhibitors significantly lowers the risk of MACE compared with clopidogrel (HR: 0.90; 95% CI: 0.82-0.98; P = .018; I = 0%). A significant reduction in risks of all-cause death and myocardial infarction was also observed with the use of potent oral P2Y inhibitors compared with clopidogrel. No significant difference in risks of stroke or TIMI non-CABG major bleeding (HR: 1.24; 95% CI: 0.90-1.73; P = .191; I = 0%) was observed between potent oral P2Y inhibitors and clopidogrel.
Potent oral P2Y inhibitors, especially ticagrelor, decrease the risk of ischemic events in MMACS patients as compared with clopidogrel, without significantly increasing major bleeding.
尽管目前的指南建议在阿司匹林的基础上加用替格瑞洛作为急性冠脉综合征（ACS）患者的抗血小板策略，但缺乏针对这一特殊人群的临床证据。在 ACS 患者中是否应使用强效口服 P2Y 抑制剂仍存在争议。
我们在 PubMed、Embase、Web of Science 和 Cochrane Library 中进行了全面检索，以确定研究替格瑞洛和普拉格雷与氯吡格雷或安慰剂在 ACS 患者中的疗效或安全性的研究。主要疗效终点是每个研究定义的主要不良心血管事件（MACE），安全性终点是 TIMI 非 CABG 大出血。
共筛选出 6102 条记录，最终纳入了 4 项研究，共 46346 例患者。与氯吡格雷相比，使用强效口服 P2Y 抑制剂可显著降低 MACE 的风险（HR：0.90；95%CI：0.82-0.98；P=0.018；I=0%）。与氯吡格雷相比，使用强效口服 P2Y 抑制剂还可显著降低全因死亡和心肌梗死的风险。但未观察到与氯吡格雷相比，强效口服 P2Y 抑制剂在卒中或 TIMI 非 CABG 大出血的风险方面有差异（HR：1.24；95%CI：0.90-1.73；P=0.191；I=0%）。
与氯吡格雷相比，强效口服 P2Y 抑制剂，尤其是替格瑞洛，可降低 ACS 患者的缺血事件风险，且不会显著增加大出血风险。
