替格瑞洛对 ACS 患者 PCI 术后冠状动脉微血管功能的影响与氯吡格雷相比：系统评价和荟萃分析。

The effect of ticagrelor on coronary microvascular function after PCI in patients with ACS compared to clopidogrel: A systematic review and meta-analysis.

机构信息

Department of Cardiology, National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China.

出版信息

PLoS One. 2023 Aug 29;18(8):e0289243. doi: 10.1371/journal.pone.0289243. eCollection 2023.

BACKGROUND

The function of coronary microcirculation is an important factor in predicting the prognosis of patients with acute coronary syndrome (ACS) who receive percutaneous coronary intervention (PCI) therapy. Ticagrelor, a type of oral P2Y12 inhibitor, is widely prescribed to ACS patients and can improve prognosis compared to clopidogrel. However, the efficacy of ticagrelor on coronary microcirculation, compared to clopidogrel, remains unclear. The objective of this meta-analysis was to determine the efficacy of ticagrelor on coronary microcirculation.

METHODS

The PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases were comprehensively searched to identify studies until November 2022. Data was pooled using the fixed effects model or random effects model based on the level of heterogeneity. Sensitivity analyses were performed to measure the effects of potential confounders.

RESULTS

After screening, 16 trials with a total of 3676 participants were ultimately included in the analysis. The meta-analysis revealed that compared to clopidogrel, patients receiving ticagrelor exhibited a more significant reduction in the IMR (WMD: -6.23, 95% CI: -8.41 to -4.04), a reduction in the cTFC (WMD: -1.88; 95% CI: -3.32 to -0.45), and greater increases in CFR (WMD: 0.38; 95% CI: 0.18 to 0.57), MBG (RR 1.29, 95% CI 1.12 to 1.48), and TIMI (RR 1.03, 95% CI 1.00 to 1.06).

CONCLUSION

Our findings suggest that, compared to clopidogrel, ticagrelor has a significant effect in reducing coronary microcirculatory resistance, enhancing coronary blood flow reserve, and improving myocardial perfusion.

背景

冠状动脉微循环功能是预测接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者预后的一个重要因素。替格瑞洛是一种口服 P2Y12 抑制剂，广泛用于 ACS 患者，与氯吡格雷相比可改善预后。然而，替格瑞洛对冠状动脉微循环的疗效与氯吡格雷相比尚不清楚。本荟萃分析旨在确定替格瑞洛对冠状动脉微循环的疗效。

方法

全面检索 PubMed、Cochrane 中央对照试验注册库（CENTRAL）和 ClinicalTrials.gov 数据库，截至 2022 年 11 月，以识别研究。根据异质性水平，采用固定效应模型或随机效应模型进行数据合并。进行敏感性分析以测量潜在混杂因素的影响。

结果

筛选后，最终纳入 16 项试验，共 3676 名参与者。荟萃分析显示，与氯吡格雷相比，接受替格瑞洛治疗的患者 IMR 降低更显著（WMD：-6.23，95%CI：-8.41 至-4.04），cTFC 降低（WMD：-1.88；95%CI：-3.32 至-0.45），CFR（WMD：0.38；95%CI：0.18 至 0.57）、MBG（RR 1.29，95%CI 1.12 至 1.48）和 TIMI（RR 1.03，95%CI 1.00 至 1.06）增加更显著。