替格瑞洛单药治疗与 PCI 后 ACS 患者短程 DAPT（<1 个月）与长程 12 个月 DAPT 的疗效和安全性：RCT 的荟萃分析。
Efficacy and safety of ticagrelor monotherapy following a brief DAPT vs. prolonged 12-month DAPT in ACS patients post-PCI: a meta-analysis of RCTs.
机构信息
Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan.
Department of Rheumatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
出版信息
Eur J Clin Pharmacol. 2024 Dec;80(12):1871-1882. doi: 10.1007/s00228-024-03747-w. Epub 2024 Sep 12.
BACKGROUND
As per current guidelines, acute coronary syndrome (ACS) patients who undergo percutaneous coronary intervention (PCI) should be started on dual antiplatelet therapy (DAPT) for a period of 12 months.
OBJECTIVE
To assess the efficacy and safety of brief DAPT (up to 3 months) succeeded by ticagrelor monotherapy compared with a 12-month DAPT in ACS patients following PCI.
METHODS
We systematically searched Cochrane, Embase, and PubMed to find relevant randomized clinical trials. Examined outcomes included the incidence of major adverse cerebrovascular and cardiovascular events (MACCE), bleeding events, and the composite incidence of net adverse clinical events (NACE).
RESULTS
Our primary analysis included 21,927 ACS patients from six RCTs. Our pooled results indicate that following PCI in individuals with ACS, brief DAPT followed by ticagrelor did not increase the risk of MACCE (OR 0.92, 95% CI 0.79-1.07) but significantly reduced the risk of minor or major bleeding (OR 0.52, 95% CI 0.44-0.62) and NACE (OR 0.71, 95% CI 0.59-0.86) compared with a long-term DAPT within a follow-up of 12 months.
CONCLUSION
Brief DAPT followed by ticagrelor monotherapy is superior to a 12-month DAPT in offering a net clinical advantage in ACS patients following PCI.
背景
根据现行指南，接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者应接受双联抗血小板治疗（DAPT）12 个月。
目的
评估 PCI 后 ACS 患者短期（最长 3 个月）DAPT 后加用替格瑞洛单药治疗与 12 个月 DAPT 的疗效和安全性。
方法
我们系统地检索了 Cochrane、Embase 和 PubMed，以查找相关的随机临床试验。评估的结局包括主要不良心脑血管事件（MACCE）、出血事件以及净不良临床事件（NACE）的复合发生率。
结果
我们的主要分析纳入了来自 6 项 RCT 的 21927 例 ACS 患者。汇总结果表明，在 ACS 患者接受 PCI 后，替格瑞洛单药替代 DAPT 不会增加 MACCE 的风险（OR 0.92，95%CI 0.79-1.07），但可显著降低 12 个月随访期间的轻微或严重出血（OR 0.52，95%CI 0.44-0.62）和 NACE（OR 0.71，95%CI 0.59-0.86）的风险。
结论
与 12 个月 DAPT 相比，PCI 后 ACS 患者替格瑞洛单药替代短期 DAPT 具有明显的净临床获益。
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