Azarboo Alireza, Daneshvar Mohammad Shahabaddin, Abroy Alireza Sattari, Assempoor Ramin, Taghvaei Aryan, Nasrollahizadeh Ali, Hajiqasemi Mohsen, Ghaseminejad-Raeini Amirhossein, Hosseini Kaveh
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Ave, Tehran, Iran.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Egypt Heart J. 2025 Jan 22;77(1):13. doi: 10.1186/s43044-025-00612-8.
Many studies have validated the use of antiplatelet or anticoagulant therapy in coronary artery ectasia (CAE) to reduce major adverse cardiovascular events (MACE); however, it is not completely known which group of these antithrombotic medications is more effective. The purpose of this systematic review and network meta-analysis was to evaluate the efficacy of different anti-thrombotic treatments in adult patients with CAE.
This systematic review and meta-analysis followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines as well as PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses and adhered to a registered predetermined methodology noted in the prospective register of systematic reviews (PROSPERO) protocol. Comprehensive searches were conducted until October 2024. Study selection, data extraction, and risk-of-bias assessments were independently performed by two reviewers. The pairwise meta-analysis compared the odds of MACE among patients receiving different antithrombotic therapies versus no treatment. The network meta-analysis (NMA) combined direct and indirect evidence to compare the efficacy of antithrombotic therapies for MACE.
Our systematic review included 5,039 adult patients suffering from CAE. The odds of MACE were higher in patients with no treatment when compared with those on dual antiplatelet therapy (DAPT) and aspirin monotherapy; although patients on anticoagulation demonstrated a lower incidence of MACE, the difference with the no treatment group did not reach statistical significance. Among various types of interventions in NMA, DAPT was the best in the treatment of CAE.
Based on the surface under the cumulative ranking curve (SUCRA) value, DAPT is the most effective treatment in the prevention of MACE for CAE patients, followed by aspirin monotherapy and anticoagulant treatment.
许多研究已证实，在冠状动脉扩张症（CAE）中使用抗血小板或抗凝治疗可减少主要不良心血管事件（MACE）；然而，尚不完全清楚哪类抗血栓药物更有效。本系统评价和网状Meta分析的目的是评估不同抗血栓治疗对成年CAE患者的疗效。
本系统评价和Meta分析遵循系统评价和Meta分析的首选报告项目（PRISMA）指南以及纳入网状Meta分析的系统评价报告的PRISMA扩展声明，并遵循系统评价前瞻性注册库（PROSPERO）方案中记录的预先注册的预定方法。截至2024年10月进行了全面检索。研究选择、数据提取和偏倚风险评估由两名研究者独立进行。成对Meta分析比较了接受不同抗血栓治疗的患者与未接受治疗的患者发生MACE的几率。网状Meta分析（NMA）结合直接和间接证据来比较抗血栓治疗对MACE的疗效。
我们的系统评价纳入了5039例成年CAE患者。与双联抗血小板治疗（DAPT）和阿司匹林单药治疗的患者相比，未接受治疗的患者发生MACE的几率更高；尽管接受抗凝治疗的患者MACE发生率较低，但与未治疗组的差异未达到统计学意义。在NMA的各种干预措施中，DAPT在CAE治疗中效果最佳。
根据累积排序曲线下面积（SUCRA）值，DAPT是预防CAE患者发生MACE最有效的治疗方法，其次是阿司匹林单药治疗和抗凝治疗。
