在接受 PCI 的缺血性心脏病患者中，单药 vs 双联 vs 三联抗血小板治疗的比较：一项网状荟萃分析。

Comparison between mono vs dual vs triple antiplatelet therapy in patients with ischemic heart disease undergoing PCI, a network meta-analysis.

机构信息

College of Medicine, University of Baghdad, Baghdad, Iraq.

Faculty of Medicine, Alexandria University, Alexandria, Egypt.

出版信息

Curr Probl Cardiol. 2024 Nov;49(11):102755. doi: 10.1016/j.cpcardiol.2024.102755. Epub 2024 Jul 28.

DOI:10.1016/j.cpcardiol.2024.102755

PMID:39079620

Abstract

AIMS

We aim to research the efficacy and safety of single(SAPT), dual(DAPT), and triple(TAPT) antiplatelets approaches across IHD patients undergoing PCI.

METHODS AND RESULTS

A network meta-analysis was conducted until April 1st, 2024, using the netmeta package in R studio 4.3.3. Primary outcomes were cardiac death, myocardial infarction(MI), stent thrombosis, stroke, and major bleeding(BARC 3-5). From 25 studies, a total of 65115 patients were included. For cardiac death, TAPT had no different risk than DAPT compared to SAPT [RR = 0.74; 95%CI (0.40 to 1.35); p-value = 0.33], [RR = 1.01, 95%CI (0.84 to 1.19); p-value = 0.87] respectively. For MI, TAPT had no different risk than DAPT compared to SAPT [RR = 0.77; 95%CI (0.51 to 1.16); p-value = 0.2047], [RR = 0.81, 95%CI (0.64 to 1.03); p-value = 0.0850] respectively. For stent thrombosis, DAPT had no different risk than TAPT compared to SAPT [RR = 0.74; 95%CI (0.45 to 1.21); p-value = 0.2284], [RR = 0.84, 95%CI (0.27 to 2.59); p-value = 0.7630] respectively. For stroke, DAPT had no different risk than TAPT in comparison to SAPT [RR = 0.91; 95%CI (0.75 to 1.10); p-value = 0.3209], and [RR = 0.87, 95%CI (0.43 to 1.76); p-value=0.6937], respectively. For Major bleeding(BARC 3-5), DAPT and TAPT increased major bleeding compared to SAPT, with only DAPT showing statistical significance. [RR = 1.43; 95%CI (1.09 to 1.88); p-value = 0.0107], and [RR = 2.78, 95%CI (0.90 to 4.78); p-value = 0.0852], respectively.

CONCLUSION

DAPT and TAPT increased the risk of bleeding events compared to SAPT. However, we found no significant differences between these regimens for the other primary outcomes.

摘要

目的

我们旨在研究缺血性心脏病（IHD）患者经皮冠状动脉介入治疗（PCI）中，单一（SAPT）、双重（DAPT）和三重（TAPT）抗血小板治疗方法的疗效和安全性。

方法和结果

我们使用 R studio 4.3.3 中的 netmeta 包，进行了一项截至 2024 年 4 月 1 日的网络荟萃分析。主要结局为心脏死亡、心肌梗死（MI）、支架血栓形成、卒中和主要出血（BARC 3-5）。从 25 项研究中，共纳入了 65115 名患者。对于心脏死亡，与 SAPT 相比，TAPT 与 DAPT 相比无不同的风险[RR=0.74；95%CI（0.40 至 1.35）；p 值=0.33]，[RR=1.01，95%CI（0.84 至 1.19）；p 值=0.87]。对于 MI，与 SAPT 相比，TAPT 与 DAPT 相比无不同的风险[RR=0.77；95%CI（0.51 至 1.16）；p 值=0.2047]，[RR=0.81，95%CI（0.64 至 1.03）；p 值=0.0850]。对于支架血栓形成，与 SAPT 相比，DAPT 与 TAPT 相比无不同的风险[RR=0.74；95%CI（0.45 至 1.21）；p 值=0.2284]，[RR=0.84，95%CI（0.27 至 2.59）；p 值=0.7630]。对于卒中和 BARC 3-5 大出血，与 SAPT 相比，DAPT 与 TAPT 相比无不同的风险[RR=0.91；95%CI（0.75 至 1.10）；p 值=0.3209]，[RR=0.87，95%CI（0.43 至 1.76）；p 值=0.6937]。对于主要出血（BARC 3-5），与 SAPT 相比，DAPT 和 TAPT 增加了大出血的风险，只有 DAPT 具有统计学意义。[RR=1.43；95%CI（1.09 至 1.88）；p 值=0.0107]，[RR=2.78，95%CI（0.90 至 4.78）；p 值=0.0852]。