National Key Laboratory of Frigid Zone Cardiovascular Diseases, Department of Cardiovascular Diseases, General Hospital of Northern Theater Command, Shenyang, China.
Department of Internal Medicine, Chinese PLA No. 31694 Army Health Company, Benxi, China.
Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231196477. doi: 10.1177/10760296231196477.
Although dual antiplatelet therapy for secondary prevention in acute coronary syndrome (ACS) is highly recommended by current guidelines, P2Y inhibitor non-adherence often occurs and devastates prognosis. To evaluate whether the ischemic risk during the early period of clopidogrel noncompliance was increased among ACS patients, a comprehensive search of PubMed, Embase, and Web of Science was conducted to identify studies reporting early ischemic risk after clopidogrel noncompliance in ACS patients. The primary endpoint was a composite of death or myocardial infarction (MI). Effect sizes were synthesized in patients with or without revascularization. A total of 7 observational studies focusing on clopidogrel noncompliance were included in this meta-analysis, whereas no studies involving ticagrelor or prasugrel were retrieved. A significantly increased risk of death or MI 0 to 90 days after clopidogrel noncompliance was found compared with that during 90 to 180 or 90 to 360 days regardless of revascularization (incidence rate ratio [IRR]: 2.01, 95% confidence interval (CI): 1.62-2.49, < .001, = 9%) or not (IRR: 1.61, 95% CI: 1.05-2.48, < .001, = 74%). Patients undergoing percutaneous coronary intervention had a higher risk of death or MI 0 to 90 days after clopidogrel noncompliance compared with 90-180 or 90-360 days irrespective of drug-eluting stent or bare metal stent implantation ( < .05 for both). The early ischemic risk after clopidogrel noncompliance is significantly higher than the late risk in ACS patients. Antiplatelet noncompliance remains a serious concern.
尽管目前的指南强烈推荐急性冠脉综合征（ACS）患者进行双联抗血小板治疗作为二级预防，但 P2Y 抑制剂的不依从现象经常发生，并严重影响预后。为了评估 ACS 患者氯吡格雷不依从期间早期缺血风险是否增加，我们全面检索了 PubMed、Embase 和 Web of Science，以确定报告 ACS 患者氯吡格雷不依从后早期缺血风险的研究。主要终点是死亡或心肌梗死（MI）的复合终点。在接受或未接受血运重建的患者中，评估了效果大小。本荟萃分析共纳入了 7 项关于氯吡格雷不依从的观察性研究，但未检索到涉及替格瑞洛或普拉格雷的研究。与 90-180 天或 90-360 天相比，无论是否进行血运重建（发生率比 [IRR]：2.01，95%置信区间 [CI]：1.62-2.49， < .001， = 9%），氯吡格雷不依从后 0-90 天内发生死亡或 MI 的风险显著增加（IRR：1.61，95% CI：1.05-2.48， < .001， = 74%）。接受经皮冠状动脉介入治疗的患者与 90-180 天或 90-360 天相比，氯吡格雷不依从后 0-90 天内发生死亡或 MI 的风险更高，无论是否植入药物洗脱支架或裸金属支架（两者均 < .05）。ACS 患者氯吡格雷不依从后的早期缺血风险明显高于晚期风险。抗血小板不依从仍然是一个严重的问题。
