Guided vs. conventional anti-platelet therapy for patients with acute coronary syndrome: A meta-analysis of randomized controlled trials

被引:0
|
作者
Zhong, Peng-Yu [1 ]
Deng, Jian-Ping [1 ]
Zhao, Jing-Hong [1 ]
Peng, Lei [2 ,3 ]
Liu, Tao [1 ]
Wang, Hao-Yu [1 ]
机构
[1] North Sichuan Med Coll, Nanchong Cent Hosp, Dept Cardiol, Clin Med Coll 2, Nanchong, Peoples R China
[2] Lanzhou Univ, Dept Urol, Med Sch, Hosp 2, Lanzhou, Peoples R China
[3] Shenzhen Univ, South China Hosp, Hlth Sci Ctr, Shenzhen, Peoples R China
来源
FRONTIERS IN CARDIOVASCULAR MEDICINE | 2023年 / 10卷
关键词
acute coronary syndrome; percutaneous coronary intervention; dual antiplatelet therapy; genotype testing; platelet function testing; PLATELET REACTIVITY; OPEN-LABEL; CLOPIDOGREL; INTERVENTION; GUIDELINES; GENOTYPE;
D O I
10.3389/fcvm.2023.1079332
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundWhether guided antiplatelet therapy in patients with acute coronary syndrome (ACS) is effective in improving net clinical benefits compared with conventional antiplatelet therapy remains controversial. Therefore, we assessed the safety and efficacy of guided antiplatelet therapy in patients with ACS and undergoing percutaneous coronary intervention.MethodWe searched PubMed, EMBASE, and Cochrane Library databases to select the relevant randomized controlled trials comparing the guided and conventional antiplatelet therapy in patients with ACS. The primary and safety outcomes are major adverse cardiovascular events (MACE) and major bleeding, respectively. The efficacy outcomes included myocardial infarction, stent thrombosis, all-cause death, and cardiovascular death. We selected the relative risk (RR) and 95% confidence intervals (CIs) as effect size and calculated it using the Review Manager software. In addition, we evaluated the final results by trial sequential analysis (registered by PROSPERO, CRD 42020210912).ResultsWe selected seven randomized controlled trials and included 8,451 patients in this meta-analysis. Guided antiplatelet therapy can significantly reduce the risk of MACE (RR 0.64, 95% CI 0.54-0.76, P < 0.00001), myocardial infarction (RR 0.62, 95% CI 0.49-0.79, P = 0.0001), all-cause death (RR 0.61, 95% CI 0.44-0.85, P = 0.003), and cardiovascular death (RR 0.66, 0.49-0.90, P = 0.009). In addition, there is no significant difference between the two groups in stent thrombosis (RR 0.67, 95% CI 0.44-1.03, P = 0.07) and major bleeding (RR 0.86, 95% CI 0.65-1.13, P = 0.27). The subgroup analysis showed that the guided group based on genotype tests could bring benefits in MACE and myocardial infarction.ConclusionsThe guided antiplatelet therapy is not only associated with a comparable risk of bleeding but also with a lower risk of MACE, myocardial infarction, all-cause death, cardiovascular death, and stent thrombosis than the conventional strategy in patients with ACS.
引用
收藏
页数:9
相关论文
共 50 条
  • [1] Optimal anti-platelet therapy for older patients with acute coronary syndrome: a network meta-analysis of randomized trials comprising 59,284 older patients
    Zhou, Shuang
    Li, Wenhui
    Xiang, Qian
    Wang, Zhe
    Zhang, Hanxu
    Mu, Guangyan
    Liu, Zhiyan
    Cui, Yimin
    JOURNAL OF THROMBOSIS AND THROMBOLYSIS, 2024, 57 (01) : 143 - 154
  • [2] Optimal anti-platelet therapy for older patients with acute coronary syndrome: a network meta-analysis of randomized trials comprising 59,284 older patients
    Shuang Zhou
    Wenhui Li
    Qian Xiang
    Zhe Wang
    Hanxu Zhang
    Guangyan Mu
    Zhiyan Liu
    Yimin Cui
    Journal of Thrombosis and Thrombolysis, 2024, 57 : 143 - 154
  • [3] Anti-platelet treatments in acute coronary syndrome: Simplified network meta-analysis
    Passaro, Doriana
    Fadda, Valeria
    Maratea, Dario
    Messori, Andrea
    INTERNATIONAL JOURNAL OF CARDIOLOGY, 2011, 150 (03) : 364 - 367
  • [4] Adenosine as adjunctive therapy in acute coronary syndrome: a meta-analysis of randomized controlled trials
    Laborante, Renzo
    Bianchini, Emiliano
    Restivo, Attilio
    Ciliberti, Giuseppe
    Galli, Mattia
    Vergallo, Rocco
    Rodolico, Daniele
    Zito, Andrea
    Princi, Giuseppe
    Leone, Antonio Maria
    Aurigemma, Cristina
    Romagnoli, Enrico
    Montone, Rocco Antonio
    Burzotta, Francesco
    Trani, Carlo
    Crea, Filippo
    D'Amario, Domenico
    EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY, 2023, 9 (02) : 173 - 182
  • [5] Glucose–insulin–potassium therapy in patients with acute coronary syndrome: a meta-analysis of randomized controlled trials
    Pei-Yin Jin
    Hai-San Zhang
    Xiao-Yan Guo
    Wei-Fang Liang
    Qin-Fu Han
    BMC Cardiovascular Disorders, 14
  • [6] Glucose-insulin-potassium therapy in patients with acute coronary syndrome: a meta-analysis of randomized controlled trials
    Jin, Pei-Yin
    Zhang, Hai-San
    Guo, Xiao-Yan
    Liang, Wei-Fang
    Han, Qin-Fu
    BMC CARDIOVASCULAR DISORDERS, 2014, 14
  • [7] Meta-Analysis of Randomized Controlled Trials Comparing Immediate vs Staged Complete Revascularization in Patients With Acute Coronary Syndrome
    Singh, Sahib
    Tantry, Udaya
    Bliden, Kevin
    Garg, Aakash
    Gurbel, Paul
    CIRCULATION, 2023, 148
  • [8] SINGLE VS. DUAL ANTIPLATELET THERAPY IN PATIENTS WITH ACUTE CORONARY SYNDROME - A META-ANALYSIS
    Ullah, Waqas
    Uddin, Mohammed Faisal
    Sandhyavenu, Harigopal
    Sattar, Yasar
    Zghouzi, Mohamed
    Suleiman, Abdul-Rahman M.
    Pasha, Ahmed
    Zahid, Salman
    Alraies, M. Chadi
    Sabouret, Pierre
    Fischman, David
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2021, 77 (18) : 18 - 18
  • [9] Dual vs triple antithrombotic therapy in atrial fibrillation and acute coronary syndrome: An updated meta-analysis of randomized controlled trials
    Sainbayar, Enkhtsogt
    Pham, Hoang Nhat
    Olson, April
    Ibrahim, Ramzi
    Grewal, Harneet
    Salih, Mohammed
    Mamas, Mamas A.
    Lee, Kwan
    JOURNAL OF INVESTIGATIVE MEDICINE, 2024, 72 (08) : 956 - 960
  • [10] Efficacy and safety of ticagrelor in patients with acute coronary syndrome: A meta-analysis of randomized controlled trials
    Jing, Yunyan
    Ni, Bin
    Zhou, Donglai
    Zhang, Xingwei
    Liu, Shanxin
    CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, 2018, 45 (02) : 122 - 126