Department of Cardiovascular Diseases, Hangzhou Xiaoshan Second People's Hospital, Hangzhou, Zhejiang, China.
Br J Hosp Med (Lond). 2024 Oct 30;85(10):1-17. doi: 10.12968/hmed.2024.0370. Epub 2024 Oct 27.
Acute coronary syndrome (ACS), a condition characterized by acute cardiac ischemia, is among the major causes of death from cardiovascular diseases (CVD). However, whether there is a correlation between platelet reactivity and major adverse cardiovascular events (MACE) remains debatable, and whether platelet function tests should be tailored for ACS patients after percutaneous coronary intervention (PCI) is still under discussion. This study aims to investigate the relationship between platelet reactivity and the occurrence of MACE in ACS patients post-PCI and to discuss the implications of these findings. Clinical studies on 'PCI, ACS, dual antiplatelet therapy (DAPT), platelet reactivity, major adverse cardiovascular events (MACE)' up to 31 October 2023, were systematically collected from Embase, PubMed, and the Cochrane Library. Twelve articles meeting predefined criteria were selected. Meta-analysis was performed using Review Manager 5.4 (Cochrane, London, UK) and Stata 15.0 (StataCorp LLC, College Station, TX, USA) to compute pooled effect sizes, assess heterogeneity, explore sources of heterogeneity, and evaluate publication bias. Twelve articles consisting of 9297 patients were included. The meta-analysis showed that ACS patients with high platelet reactivity (HPR) who received PCI and used DAPT for 1-2 years had a greater risk of MACE (risk ratio (RR) = 1.79, 95% confidence interval (CI): 1.30-2.46) compared to those with low platelet reactivity. Moreover, greater platelet reactivity was associated independently with all-cause mortality (RR = 2.26, 95% CI: 1.63-3.12), cardiac mortality (RR = 2.87, 95% CI: 2.16-3.8), myocardial infarction (RR = 1.98, 95% CI: 1.53-2.5), in-stent restenosis (RR = 1.87, 95% CI: 1.22-2.87), as well as stroke (RR = 1.62, 95% CI: 1.02-2.57), but not with coronary revascularization events (RR = 0.99, 0.96, 95% CI: 0.80-1.24). On the other hand, meta-regression revealed that region ( = 0.99), type of ACS patient ( = 0.16), drug regimen ( = 0.48), testing method ( = 0.51), sampling time ( = 0.70), follow-up time ( = 0.45), and PCI protocol ( = 0.27) were not sources of heterogeneity in the study. The meta-analysis outcomes indicate that in ACS patients receiving PCI and using dual antiplatelet therapy for 1-2 years, HPR was independently positively correlated with major adverse cardiovascular events, all-cause (or cardiac) mortality, recurrent myocardial infarction, in-stent restenosis, and stroke. This suggests that platelet reactivity testing has clinical and translational significance in predicting patients' risk of adverse cardiovascular events.
急性冠状动脉综合征（ACS）是一种以急性心肌缺血为特征的疾病，是心血管疾病（CVD）死亡的主要原因之一。然而，血小板反应性与主要不良心血管事件（MACE）之间是否存在相关性仍存在争议，并且在经皮冠状动脉介入治疗（PCI）后是否应该针对 ACS 患者进行血小板功能测试仍在讨论中。本研究旨在探讨 PCI 后 ACS 患者血小板反应性与 MACE 发生之间的关系，并讨论这些发现的意义。
截至 2023 年 10 月 31 日，系统地从 Embase、PubMed 和 Cochrane Library 中检索了关于“PCI、ACS、双重抗血小板治疗（DAPT）、血小板反应性、主要不良心血管事件（MACE）”的临床研究。选择了符合预定标准的 12 篇文章。使用 Review Manager 5.4（Cochrane，伦敦，英国）和 Stata 15.0（StataCorp LLC，德克萨斯州 College Station）进行荟萃分析，以计算合并效应大小、评估异质性、探索异质性来源以及评估发表偏倚。
纳入了 12 篇包含 9297 名患者的文章。荟萃分析显示，接受 PCI 并使用 DAPT 治疗 1-2 年的 ACS 患者中，高血小板反应性（HPR）患者发生 MACE 的风险更高（风险比（RR）=1.79，95%置信区间（CI）：1.30-2.46）与低血小板反应性患者相比。此外，更高的血小板反应性与全因死亡率（RR=2.26，95%CI：1.63-3.12）、心脏死亡率（RR=2.87，95%CI：2.16-3.8）、心肌梗死（RR=1.98，95%CI：1.53-2.5）、支架内再狭窄（RR=1.87，95%CI：1.22-2.87）以及中风（RR=1.62，95%CI：1.02-2.57）独立相关，但与冠状动脉血运重建事件（RR=0.99，95%CI：0.80-1.24）无关。另一方面，元回归显示，区域（=0.99）、ACS 患者类型（=0.16）、药物方案（=0.48）、检测方法（=0.51）、采样时间（=0.70）、随访时间（=0.45）和 PCI 方案（=0.27）不是研究中异质性的来源。
荟萃分析结果表明，在接受 PCI 和使用双重抗血小板治疗 1-2 年的 ACS 患者中，HPR 与主要不良心血管事件、全因（或心脏）死亡率、复发性心肌梗死、支架内再狭窄和中风独立呈正相关。这表明血小板反应性检测在预测患者不良心血管事件风险方面具有临床和转化意义。
