Department of Cardiology, GCS Medical College and Research Centre, Ahmedabad, India.
Rawalpindi Medical University, Rawalpindi, Pakistan.
Coron Artery Dis. 2024 Nov 1;35(7):590-597. doi: 10.1097/MCA.0000000000001417. Epub 2024 Aug 23.
The optimum duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS) remains controversial. Ticagrelor monotherapy after short duration of DAPT (1-3 months) is a subject of research. We conducted an updated systematic review and meta-analysis comparing the ticagrelor monotherapy with continued DAPT after short duration of DAPT in patients with ACS undergoing PCI.
PubMed, Embase, and Cochrane databases were searched for studies comparing ticagrelor monotherapy to DAPT after PCI and reported the outcomes of major adverse cardiovascular and cerebrovascular events (MACCE); net adverse clinical events (NACE); myocardial infarction (MI); major bleeding; death from any cause; definite or probable stent thrombosis; and target vessel revascularization (TVR). Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Statistical analysis was performed using Review Manager (Cochrane collaboration). Heterogeneity was examined with I2 test.
Of 3,208 results, five studies with 21,407 patients were included of which 50% received ticagrelor monotherapy. Studies had reported follow up of 12 months. Major bleeding [hazard ratio 0.47; 95% confidence interval (CI), 0.37-0.61; P < 0.001], NACE (hazard ratio 0.71; 95% CI, 0.56-0.90; P = 0.005), and all-cause death (hazard ratio 0.76; 95% CI, 0.59-0.98; P = 0.04) were significantly less with ticagrelor monotherapy. Other outcomes were comparable in both groups.
In patients with ACS undergoing PCI, ticagrelor monotherapy reduces major bleeding, NACE and all-cause death as compared to continued DAPT for 12 months. Major ischemic outcomes were similar. Ticagrelor monotherapy is the way forward after short duration of DAPT after PCI in ACS.
急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）后双联抗血小板治疗（DAPT）的最佳持续时间仍存在争议。DAPT 持续时间较短（1-3 个月）后使用替格瑞洛单药治疗是研究的主题。我们进行了一项更新的系统评价和荟萃分析，比较了 ACS 患者 PCI 后短期 DAPT 后替格瑞洛单药治疗与继续 DAPT 的疗效。
检索 PubMed、Embase 和 Cochrane 数据库，比较 PCI 后替格瑞洛单药治疗与 DAPT 的研究，并报告主要不良心脑血管事件（MACCE）；净不良临床事件（NACE）；心肌梗死（MI）；主要出血；任何原因死亡；确定或可能的支架血栓形成；以及靶血管血运重建（TVR）的结果。从已发表的报告中提取数据，并按照 Cochrane 建议进行质量评估。使用 Review Manager（Cochrane 协作）进行统计分析。使用 I2 检验检查异质性。
在 3208 项结果中，纳入了 5 项研究共 21407 例患者，其中 50%接受替格瑞洛单药治疗。研究报告了 12 个月的随访。主要出血[风险比 0.47；95%置信区间（CI），0.37-0.61；P ＜0.001]、NACE（风险比 0.71；95%CI，0.56-0.90；P ＝0.005）和全因死亡（风险比 0.76；95%CI，0.59-0.98；P ＝0.04）的风险显著降低。两组其他结局相当。
在接受 PCI 的 ACS 患者中，与继续 DAPT 治疗 12 个月相比，替格瑞洛单药治疗可减少主要出血、NACE 和全因死亡。主要缺血结局相似。在 ACS 患者 PCI 后短期 DAPT 后，替格瑞洛单药治疗是一种可行的方法。
