Thomas Jefferson University Hospitals Philadelphia PA.
UT Health San Antonio San Antonio TX.
J Am Heart Assoc. 2024 Oct 15;13(20):e032490. doi: 10.1161/JAHA.122.032490. Epub 2024 Oct 11.
Optimal duration and choice of antiplatelet therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention remain controversial.
Digital databases (PubMed, Cochrane, and Embase) were queried to select all randomized controlled trials on a post-percutaneous coronary intervention population with acute coronary syndrome. Dual-antiplatelet therapy (DAPT) with aspirin and clopidogrel for 12 months was compared with 4 major strategies: high-potency, high- to low-potency, low-dose, and short-duration DAPT. A network meta-analysis was performed to compare the safety and efficacy of different antiplatelet strategies. This study was the second updated manuscript under the International Prospective Register of Systematic Review registration (CRD42021286552). Thirty-two randomized controlled trials comprising 103 459 (51 750 experimental, 51 709 control) patients were included. Compared with DAPT with aspirin and clopidogrel for 12 months, high- to low-potency DAPT (risk ratio [RR], 0.69 [95% CI, 0.52-0.92]) and aspirin+prasugrel containing DAPT for 12 months (RR, 0.84 [95% CI, 0.72-0.98]) had a significantly lower, whereas DAPT for 1 month followed by clopidogrel only (RR, 1.59 [95% CI, 1.06-2.39]) had a higher, incidence of major adverse cardiovascular events at 1 year (median follow-up). Prasugrel (RR, 1.35 [95% CI, 1.09-1.66]) and ticagrelor (RR, 1.38 [95% CI, 1.17-1.62]) containing DAPT for 12 months had significantly higher rates, whereas high- to low-potency DAPT (RR, 0.85 [95% CI, 0.63-1.15]) had no significant risk of major bleeding.
Aspirin and ticagrelor for 3 months, followed by aspirin and clopidogrel for the remaining duration, can be considered the optimal strategy for treating post-percutaneous coronary intervention patients with acute coronary syndrome because of a significantly reduced risk of major adverse cardiovascular events without increasing the risk of bleeding.
经皮冠状动脉介入治疗后急性冠状动脉综合征患者的最佳抗血小板治疗持续时间和选择仍存在争议。
在经皮冠状动脉介入治疗后的急性冠状动脉综合征患者人群中，检索了数字数据库（PubMed、Cochrane 和 Embase）以选择所有随机对照试验。阿司匹林和氯吡格雷双联抗血小板治疗（DAPT）12 个月与 4 种主要策略进行比较：高、中-低效能、低剂量和短疗程 DAPT。进行了网络荟萃分析以比较不同抗血小板策略的安全性和疗效。本研究是国际前瞻性系统评价注册处（CRD42021286552）下的第二个更新手稿。共纳入 32 项随机对照试验，包括 103459 例（51750 例试验组，51709 例对照组）患者。与阿司匹林和氯吡格雷双联抗血小板治疗 12 个月相比，中-低效能 DAPT（风险比 [RR]，0.69 [95%置信区间，0.52-0.92]）和阿司匹林+普拉格雷双联抗血小板治疗 12 个月（RR，0.84 [95%置信区间，0.72-0.98]）的主要不良心血管事件发生率显著降低，而双联抗血小板治疗 1 个月后仅用氯吡格雷（RR，1.59 [95%置信区间，1.06-2.39]）的发生率则显著升高。替格瑞洛（RR，1.38 [95%置信区间，1.17-1.62]）和普拉格雷（RR，1.35 [95%置信区间，1.09-1.66]）双联抗血小板治疗 12 个月的大出血发生率显著升高，而中-低效能 DAPT（RR，0.85 [95%置信区间，0.63-1.15]）无大出血风险增加。
替格瑞洛或阿司匹林联合治疗 3 个月，随后阿司匹林和氯吡格雷再治疗其余时间，可作为经皮冠状动脉介入治疗后急性冠状动脉综合征患者的最佳治疗策略，因为主要不良心血管事件的风险显著降低，而出血风险无增加。
