Gargiulo G, Serino F, Esposito G
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Eur Rev Med Pharmacol Sci. 2022 Apr;26(7):2524-2542. doi: 10.26355/eurrev_202204_28490.
The purpose of this review is to discuss cardiovascular mortality as clinical outcome in the setting of both acute and chronic coronary syndromes (ACS and CCS) with a focus on the clinical evidence supporting the mortality benefit of ticagrelor across multiple subpopulations.
Papers considered for this review were retrieved from a PubMed search, using different combinations of keywords (e.g., mortality AND coronary syndrome AND dual antiplatelet therapy AND ticagrelor), without limitations in terms of publication date and language.
Prevention of ischemic events and death is of outmost relevance in patients with ACS and CCS, given the high rate of recurrence of such events and fatalities. Owing to the evolving nature of patients with CCS, characterized by a broad spectrum of clinical presentations and previous medical history, as well as the advances in the therapeutic and invasive management of ACS, greater attention to the rate of hard clinical outcomes, improvement in the long-term prognosis, and reduction in the residual risk of recurrent events are increasingly reported among cardiologists. Dual antiplatelet therapy (DAPT) is the cornerstone of antithrombotic therapy aimed at lowering the rate of ischemic events and death in patients treated both conservatively and invasively after ACS, as well as improving prognosis in patients with CCS. Significant differences are emerging among oral P2Y12 inhibitors with regards to mortality benefit.
Ticagrelor is an effective and well-tolerated option to attain a meaningful and clinically relevant reduction in cardiovascular mortality in both acute and chronic settings across a broad range of high-risk patient subpopulations with an acceptable payoff in terms of bleeding risk.
本综述旨在探讨急性和慢性冠状动脉综合征（ACS和CCS）背景下的心血管死亡率这一临床结局，重点关注支持替格瑞洛在多个亚组人群中降低死亡率获益的临床证据。
本综述纳入的论文通过PubMed检索获得，使用了不同关键词组合（如死亡率、冠状动脉综合征、双联抗血小板治疗、替格瑞洛），对发表日期和语言无限制。
鉴于缺血事件和死亡的高复发率，预防缺血事件和死亡在ACS和CCS患者中至关重要。由于CCS患者情况不断变化，其临床表现和既往病史具有广泛多样性，以及ACS治疗和介入管理方面的进展，心脏病专家越来越多地关注硬临床结局发生率、改善长期预后以及降低复发事件的残余风险。双联抗血小板治疗（DAPT）是抗血栓治疗的基石，旨在降低ACS患者保守治疗和介入治疗后缺血事件和死亡的发生率，并改善CCS患者的预后。在口服P2Y12抑制剂的死亡率获益方面正出现显著差异。
替格瑞洛是一种有效且耐受性良好的选择，可在急性和慢性情况下，在广泛的高危患者亚组中实现有意义且与临床相关的心血管死亡率降低，同时在出血风险方面有可接受的获益。
