Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN.
Department of Medicine, Staten Island University Hospital, Staten Island, NY.
Mayo Clin Proc. 2022 Jun;97(6):1074-1085. doi: 10.1016/j.mayocp.2022.02.016.
To evaluate the outcomes, safety, and efficacy of dual antiplatelet therapy (DAPT) with newer P2Y inhibitors compared with clopidogrel in patients with acute myocardial infarction (AMI) complicated by cardiac arrest (CA) or cardiogenic shock (CS).
MEDLINE, EMBASE, and the Cochrane Library were queried systematically from inception to January 2021 for comparative studies of adults (≥18 years) with AMI-CA/CS receiving DAPT with newer P2Y inhibitors as opposed to clopidogrel. We compared outcomes (30-day or in-hospital and 1-year all-cause mortality, major bleeding, and definite stent thrombosis) of newer P2Y inhibitors and clopidogrel in patients with AMI-CA/CS.
Eight studies (1 randomized trial and 7 cohort studies) comprising 1100 patients (695 [63.2%] receiving clopidogrel and 405 [36.8%] receiving ticagrelor or prasugrel) were included. The population was mostly male (68.5%-86.7%). Risk of bias was low for these studies, with between-study heterogeneity and subgroup differences not statistically significant. Compared with the clopidogrel cohort, the newer P2Y cohort had lower rates of early mortality (odds ratio [OR], 0.60; 95% CI, 0.45 to 0.81; P=.001) (7 studies) and 1-year mortality (OR, 0.51; 95% CI, 0.36 to 0.71; P<.001) (3 studies). We did not find a significant difference in major bleeding (OR, 1.21; 95% CI, 0.71 to 2.06; P=.48) (6 studies) or definite stent thrombosis (OR, 2.01; 95% CI, 0.63 to 6.45; P=.24) (7 studies).
In patients with AMI-CA/CS receiving DAPT, compared with clopidogrel, newer P2Y inhibitors were associated with lower rates of early and 1-year mortality. Data on major bleeding and stent thrombosis were inconclusive.
评估与氯吡格雷相比，新型 P2Y 抑制剂双联抗血小板治疗（DAPT）在伴有心脏骤停（CA）或心源性休克（CS）的急性心肌梗死（AMI）患者中的疗效、安全性。
从建库至 2021 年 1 月，系统检索 MEDLINE、EMBASE 和 Cochrane 图书馆中关于接受新型 P2Y 抑制剂 DAPT 的伴有 AMI-CA/CS 的成年人（≥18 岁）的对照研究。我们比较了新型 P2Y 抑制剂和氯吡格雷在伴有 AMI-CA/CS 的患者中的预后（30 天或住院期间和 1 年全因死亡率、大出血和明确的支架血栓形成）。
纳入 8 项研究（1 项随机试验和 7 项队列研究），共 1100 例患者（695 例接受氯吡格雷治疗，405 例接受替格瑞洛或普拉格雷治疗）。患者人群主要为男性（68.5%~86.7%）。这些研究的偏倚风险较低，组间异质性和亚组差异无统计学意义。与氯吡格雷组相比，新型 P2Y 抑制剂组的早期死亡率（比值比 [OR]，0.60；95%置信区间 [CI]，0.45 至 0.81；P=.001）（7 项研究）和 1 年死亡率（OR，0.51；95% CI，0.36 至 0.71；P<.001）（3 项研究）均较低。我们未发现大出血（OR，1.21；95% CI，0.71 至 2.06；P=.48）（6 项研究）或明确的支架血栓形成（OR，2.01；95% CI，0.63 至 6.45；P=.24）（7 项研究）存在显著差异。
在接受 DAPT 的伴有 AMI-CA/CS 的患者中，与氯吡格雷相比，新型 P2Y 抑制剂与较低的早期和 1 年死亡率相关。关于大出血和支架血栓形成的数据尚无定论。
