Gao Tong, Meng Chang, Wang Yintang, Li Siyuan, Bi Lei, Geng Yu, Zhang Ping
Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, 102218 Beijing, China.
Department of Emergency, Emergency General Hospital, 100028 Beijing, China.
Rev Cardiovasc Med. 2023 Oct 8;24(10):284. doi: 10.31083/j.rcm2410284. eCollection 2023 Oct.
With the publication of a large number of clinical studies on antiplatelet therapy in recent years, it is still controversial which antiplatelet monotherapy should be continued after a period of dual antiplatelet therapy (DAPT) in the post percutaneous coronary intervention (post-PCI) population. We conducted a meta-analysis to investigate the efficacy and safety of inhibitors versus aspirin in the post-PCI population after completing DAPT.
We searched studies in electronic databases from January 1, 2015 to November 20, 2022. We conducted a meta-analysis to estimate the effect of inhibitor monotherapy on clinical end-points in post-PCI patients after a period of DAPT, using trial-level data with consistent end-point definitions. The primary outcome was major adverse cardiovascular events (MACE). Odd ratio (OR) was pooled with 95% confidence interval (CI) for dichotomous data. This study is registered with INPLASY 2022120011.
We included five studies that included 24,460 patients. The patients who received a inhibitor showed a lower risk of MACE than patients who received aspirin (OR 0.70 [95% CI 0.60-0.80], = 0%, 0.00001) monotherapy. Subgroup analysis of MACE based on patient characteristics showed consistent results with the main analysis. The risk of major bleeding was similar in patients who received a inhibitor and those who received aspirin (OR 0.86 [95% CI 0.53-1.39], = 57%, = 0.54). The risk of major bleeding was borderline increased in patients who received ticagrelor versus aspirin (OR 1.81 [95% CI 0.99-3.31], = 0.05).
In the post-PCI population, inhibitor monotherapy may be superior to aspirin for MACE, repeat revascularization, and stroke without increasing the risk of major bleeding.
近年来，随着大量关于抗血小板治疗的临床研究发表，对于经皮冠状动脉介入治疗（PCI）后人群在一段时间的双联抗血小板治疗（DAPT）后应继续哪种抗血小板单药治疗仍存在争议。我们进行了一项荟萃分析，以研究在完成DAPT后，PCI后人群中使用[具体抑制剂名称]抑制剂与阿司匹林相比的疗效和安全性。
我们检索了2015年1月1日至2022年11月20日电子数据库中的研究。我们进行了一项荟萃分析，使用具有一致终点定义的试验水平数据，以估计在一段时间的DAPT后，[具体抑制剂名称]抑制剂单药治疗对PCI后患者临床终点的影响。主要结局是主要不良心血管事件（MACE）。对于二分数据，汇总比值比（OR）及其95%置信区间（CI）。本研究已在INPLASY 2022120011注册。
我们纳入了五项研究，共24460例患者。接受[具体抑制剂名称]抑制剂治疗的患者发生MACE的风险低于接受阿司匹林单药治疗的患者（OR 0.70 [95% CI 0.60 - 0.80]，P = 0%，P = 0.00001）。基于患者特征的MACE亚组分析结果与主要分析一致。接受[具体抑制剂名称]抑制剂治疗的患者与接受阿司匹林治疗的患者发生大出血的风险相似（OR 0.86 [9% CI 0.53 - 1.39]，P = 57%，P = 0.54）。与阿司匹林相比，接受替格瑞洛治疗的患者大出血风险有临界性增加（OR 1.81 [95% CI 0.99 - 3.31]，P = 0.05）。
在PCI后人群中，[具体抑制剂名称]抑制剂单药治疗在预防MACE、重复血运重建和中风方面可能优于阿司匹林，且不增加大出血风险。
