Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis
Abstract Background For patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), the efficacy and safety of novel P2Y12 antagonists, including prasugrel or ticagrelor, has not been established relative to that of the clopidogrel-based trip...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | BMC Cardiovascular Disorders |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12872-020-01403-6 |
| _version_ | 1818457897881829376 |
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| author | Zhe Wang Da-Yan Zhou Yong Su Liang-Yi Si Qiang Xu |
| author_facet | Zhe Wang Da-Yan Zhou Yong Su Liang-Yi Si Qiang Xu |
| author_sort | Zhe Wang |
| collection | DOAJ |
| description | Abstract Background For patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), the efficacy and safety of novel P2Y12 antagonists, including prasugrel or ticagrelor, has not been established relative to that of the clopidogrel-based triple-antiplatelet treatments (TAPTs; in combination with glycoprotein IIb/IIIa inhibitor). The present meta-analysis evaluated the efficacy and safety of prasugrel- or ticagrelor-based TAPTs relative to that of clopidogrel TAPTs in patients with STEMI undergoing PCI. Methods The databases PubMed, Embase, and Cochrane’s Library were systematically searched for relevant randomized controlled trials concerning prasugrel or ticagrelor (test) relative to clopidogrel (control). Depending on heterogeneity, studies were pooled with a random effects or a fixed effects model. Outcomes of blood flow after PCI were evaluated, including TIMI (thrombolysis in myocardial infarction), bleeding events, and major adverse cardiovascular events (MACEs). Results Seven studies comprising 11,874 patients conformed to the inclusion criteria. The pooled results with the fixed effects model indicated that after PCI patients in the prasugrel or ticagrelor groups were as likely as those treated with clopidogrel to achieve TIMI grade 3 flow or experience bleeding events. However, compared with the control, the test groups had significantly less risk of MACE (OR: 0.81, 95% CI: 0.70–0.94, P = 0.004), especially at the 1-year follow-up (OR: 0.79, 95% CI: 0.66–0.95, P = 0.01). Conclusions A prasugrel- or ticagrelor-based TAPT may reduce the rate of MACEs, without increasing bleeding in STEMI patients undergoing PCI. However, due to the limited RCT studies and variations in study weight, results of this meta-analysis should be confirmed in a large RCT with adequate sample size and follow-up duration. |
| first_indexed | 2024-12-14T22:49:52Z |
| format | Article |
| id | doaj.art-62992ce01ac64f20a4de4eb576b9f4b9 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-12-14T22:49:52Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-62992ce01ac64f20a4de4eb576b9f4b92022-12-21T22:44:45ZengBMCBMC Cardiovascular Disorders1471-22612020-03-012011710.1186/s12872-020-01403-6Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysisZhe Wang0Da-Yan Zhou1Yong Su2Liang-Yi Si3Qiang Xu4Department of Cardiology, Chongqing Fifth People’s HospitalDepartment of Cardiology, Chongqing Fifth People’s HospitalDepartment of Cardiology, Chongqing Fifth People’s HospitalDepartment of Cardiology, First Hospital Affiliated of Military Medical University (Southwest Hospital)Department of Cardiology, Chongqing Fifth People’s HospitalAbstract Background For patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), the efficacy and safety of novel P2Y12 antagonists, including prasugrel or ticagrelor, has not been established relative to that of the clopidogrel-based triple-antiplatelet treatments (TAPTs; in combination with glycoprotein IIb/IIIa inhibitor). The present meta-analysis evaluated the efficacy and safety of prasugrel- or ticagrelor-based TAPTs relative to that of clopidogrel TAPTs in patients with STEMI undergoing PCI. Methods The databases PubMed, Embase, and Cochrane’s Library were systematically searched for relevant randomized controlled trials concerning prasugrel or ticagrelor (test) relative to clopidogrel (control). Depending on heterogeneity, studies were pooled with a random effects or a fixed effects model. Outcomes of blood flow after PCI were evaluated, including TIMI (thrombolysis in myocardial infarction), bleeding events, and major adverse cardiovascular events (MACEs). Results Seven studies comprising 11,874 patients conformed to the inclusion criteria. The pooled results with the fixed effects model indicated that after PCI patients in the prasugrel or ticagrelor groups were as likely as those treated with clopidogrel to achieve TIMI grade 3 flow or experience bleeding events. However, compared with the control, the test groups had significantly less risk of MACE (OR: 0.81, 95% CI: 0.70–0.94, P = 0.004), especially at the 1-year follow-up (OR: 0.79, 95% CI: 0.66–0.95, P = 0.01). Conclusions A prasugrel- or ticagrelor-based TAPT may reduce the rate of MACEs, without increasing bleeding in STEMI patients undergoing PCI. However, due to the limited RCT studies and variations in study weight, results of this meta-analysis should be confirmed in a large RCT with adequate sample size and follow-up duration.http://link.springer.com/article/10.1186/s12872-020-01403-6PrasugrelTicagrelorGlycoprotein IIb/IIIa inhibitorST segment elevation myocardial infarctionMeta-analysis |
| spellingShingle | Zhe Wang Da-Yan Zhou Yong Su Liang-Yi Si Qiang Xu Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis BMC Cardiovascular Disorders Prasugrel Ticagrelor Glycoprotein IIb/IIIa inhibitor ST segment elevation myocardial infarction Meta-analysis |
| title | Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis |
| title_full | Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis |
| title_fullStr | Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis |
| title_full_unstemmed | Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis |
| title_short | Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis |
| title_sort | prasugrel or ticagrelor relative to clopidogrel in triple antiplatelet treatment combined with glycoprotein iib iiia inhibitor for patients with stemi undergoing pci a meta analysis |
| topic | Prasugrel Ticagrelor Glycoprotein IIb/IIIa inhibitor ST segment elevation myocardial infarction Meta-analysis |
| url | http://link.springer.com/article/10.1186/s12872-020-01403-6 |
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