中国急性冠状动脉综合征人群应用替格瑞洛有效性和安全性的Meta分析The efficacy and safety of ticagrelor in Chinese patients with acute coronary syndrome: A Meta-analysis
臧雁翔,刘广忠,王健,周俊松,李康,李为民,陈默
摘要(Abstract):
目的研究中国急性冠状动脉综合征(ACS)人群应用替格瑞洛的有效性和安全性。方法检索PubMed、EMbase、考克兰图书馆、中国知网、万方医学网等数据库,研究设计类型为随机对照临床试验(RCT)或倾向性评分匹配(PSM)的观察性研究,检索时间由建库至2019年12月5日,结局指标包括有效性和安全性两方面,其中有效性指标包括首要终点事件(心原性死亡、心肌梗死或卒中)、次要终点事件(心原性死亡、全因死亡以及卒中),安全性指标包括出血、大出血和小出血。结果共纳入12项研究进行Meta分析,其中7项RCT、5项PSM。与氯吡格雷相比,中国ACS人群应用替格瑞洛后首要终点事件发生率降低38%(RR 0.62,95%CI 0.49~0.79,P<0.001),心原性死亡以及卒中发生率分别降低42%和40%(P<0.05),但并未降低全因死亡发生率。在安全性上,与氯吡格雷相比,中国ACS人群应用替格瑞洛后并未增加大出血发生率(RR 0.89,95%CI 0.72~1.08,P=0.232),但出血和小出血发生率分别增加了49%和86%(P<0.05)。结论中国ACS人群应用替格瑞洛能够改善预后,降低不良事件发生率,但出血事件发生率相应增加,以小出血事件为主。
关键词(KeyWords): 急性冠状动脉综合征;中国人群;替格瑞洛;氯吡格雷;有效性;安全性
基金项目(Foundation): 哈尔滨高层次人才基金(2013SYYRCYJ06)
作者(Author): 臧雁翔,刘广忠,王健,周俊松,李康,李为民,陈默
参考文献(References):
- [1]Capodanno D,Alfonso F,Levine GN,et al.ACC/AHA versus ESC guidelines on dual antiplatelet therapy:JACC guideline comparison.J Am Coll Cardiol,2018,72(23 Pt A):2915-2931.
- [2]Kang J,Kim HS.The evolving concept of dual antiplatelet therapy after percutaneous coronary intervention:focus on unique feature of East Asian and“Asian Paradox”.Korean Circ J,2018,48(7):537-551.
- [3]Yun JE,Kim YJ,Park JJ,et al.Safety and eff ectiveness of contemporary P2Y12 inhibitors in an east Asian population with acute coronary syndrome:a nationwide population-based cohort study.J Am Heart Assoc,2019,8(14):e012078.
- [4]聂小燕,刘健,扶宇,等.急性冠状动脉综合征二级预防用药与血小板功能相关性的观察研究.中国介入心脏病学杂志,2018,26(2):80-86.
- [5]He M,Li D,Zhang Y,et al.Eff ects of diff erent doses of ticagrelor on platelet aggregation and endothelial function in diabetic patients with stable coronary artery disease.Platelets,2019,30(6):752-761.
- [6]Kang HJ,Clare RM,Gao R,et al.Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome:A retrospective analysis from the platelet inhibition and patient outcomes(PLATO)trial.Am Heart J,2015,169(6):899-905.e1.
- [7]Higgins JP,Altman DG,G?tzsche PC,et al.The cochrane collaboration's tool for assessing risk of bias in randomised trials.BMJ,2011,343:d5928.
- [8]夏经钢,曲杨,胡少东,等.替格瑞洛对急性ST段抬高型心肌梗死患者行急诊介入治疗的中期随访.北京大学学报(医学版),2015,(3):494-498.
- [9]Chen IC,Lee CH,Fang CC,et al.Effi cacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome in Taiwan:a multicenter retrospective pilot study.J Chin Med Assoc,2016,79(10):521-530.
- [10]Wang H,Wang X.Effi cacy and safety outcomes of ticagrelor compared with clopidogrel in elderly Chinese patients with acute coronary syndrome.Ther Clin Risk Manag,2016,12:1101-1105.
- [11]Lu Y,Li Y,Yao R,et al.Clinical eff ect of ticagrelor administered in acute coronary syndrome patients f ollowing percutaneous coronary intervention.Exp Ther Med,2016,11(6):2177-2184.
- [12]Tang X,Li R,Jing Q,et al.Assessment of ticagrelor versus clopidogrel treatment in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.JCardiovasc Pharmacol,2016,68(2):115-120.
- [13]Lee CH,Cheng CL,Kao Yang YH,et al.Cardiovascular and bleeding risks in acute myocardial infarction newly treated with ticagrelor vs.clopidogrel in Taiwan.Circ J,2018,82(3):747-756.
- [14]Gao CZ,Ma QQ,Wu J,et al.Comparison of the eff ects of ticagrelor and clopidogrel on inf lammatory f actors,vascular endothelium functions and Short-term prognosis in patients with acute ST-Segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention:a pilot study.Cell Physiol Biochem,2018,48(1):385-396.
- [15]Wu HB,Tian HP,Wang XC,et al.Clinical effi cacy of ticagrelor in patients undergoing emergency intervention for acute myocardial infarction and its impact on platelet aggregation rate.Am J Transl Res,2018,10(7):2175-2183.
- [16]Wang HY,Li Y,Xu XM,et al.Impact of baseline bleeding risk on efficacy and safety of ticagrelor versus clopidogrel in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention.Chin Med J(Engl),2018,131(17):2017-2024.
- [17]Cao B,Qu F,Liu X,et al.Short-term effi cacy of ticagrelor in acute ST-segment elevation myocardial infarction patients undergoing an emergency percutaneous coronary intervention.Aging,2019,11(20):8925-8936.
- [18]Sun Y,Li C,Zhang L,et al.Clinical outcomes after ticagrelor and clopidogrel in Chinese post-stented patients.Atherosclerosis,2019,290:52-58.
- [19]Zheng W,Li Y,Tian J,et al.Eff ects of ticagrelor versus clopidogrel in patients with coronary bifurcation lesions undergoing percutaneous coronary intervention.Biomed Res Int,2019,2019:3170957.
- [20]Gao R,Wu Y,Liu H,et al.Safety and incidence of cardiovascular events in Chinese patients with acute coronary syndrome treated with ticagrelor:the 12-month,phaseⅣ,multicenter,single-arm DAYUstudy.Cardiovasc Drugs Ther,2018,32(1):47-56.
- [21]Du X,Zheng Y,Yang P,et al.YINGLONG:a multicenter,prospective,non-interventional study evaluating the safety and tolerability of ticagrelor in Chinese patients with acute coronary syndrome.Adv Ther,2019,36(7):1595-1605.
- [22]Gan XD,Wei BZ,Fang D,et al.Effi cacy and safety analysis of new P2Y12 inhibitors versus clopidogrel in patients with percutaneous coronary intervention:a Meta-analysis.Curr Med Res Opin,2015,31(12):2313-2323.
- [23]Misumida N,Aoi S,Kim SM,et al.Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome:Systematic review and meta-analysis.Cardiovasc Revasc Med,2018,19(6):689-694.
- [24]He M,Li D,Zhang Y,et al.Eff ects of diff erent doses of ticagrelor on platelet aggregation and endothelial function in diabetic patients with stable coronary artery disease.Platelets,2019,30(6):752-761.
- [25]Lindholm D,Varenhorst C,Cannon CP,et al.Ticagrelor vs.clopidogrel in patients with non-ST-elevation acute coronary syndrome with or without revascularization:results f rom the PLATO trial.Eur Heart J,2014,35(31):2083-2093.
- [26]Takahashi K,Serruys PW,Chichareon P,et al.Effi cacy and safety of ticagrel or monotherapy in patients undergoing multivessel PCI.JAm Coll Cardiol,2019,74(16):2015-2027.
- [27]Asher E,Frydman S,Katz M,et al.Chewing versus swallowing ticagrelor to accelerate platelet inhibition in acute coronary syndrome-the CHEERS study.Thromb Haemost,2017,117(4):727-733.
- [28]Asher E,Tal S,Mazin I,et al.Eff ect of chewing vs swallowing ticagrelor on platelet inhibition in patients with ST-segment elevation myocardial infarction:a randomized clinical trial.JAMA Cardiol,2017,2(12):1380-1384.
- [29]Chichareon P,Modolo R,Kerkmeijer L,et al.Association of sex with outcomes in patients undergoing percutaneous coronary intervention:a subgroup analysis of the GLOBAL LEADERSrandomized clinical trial.JAMA Cardiol,2019,5(1):1-10.
- [30]Wang C,Zheng W,Shaqdan A,et al.Effi cacy and safety of switching from ticagrelor to clopidogrel during the early and late phase in acute coronary syndrome patients af ter percutaneous coronary intervention.Platelets,2019,31(3):1-7.
- [31]Hong J,Turgeon RD,Pearson GJ.Switching to clopidogrel in patients with acute coronary syndrome managed with percutaneous coronary intervention initially treated with prasugrel or ticagrelor:systematic review and meta-analysis.Ann Pharmacother,2019,53(10):997-1004.
- [32]Ahrens I,Averkov O,Zú?iga EC,et al.Invasive and antiplatelet treatment of patients with non-ST-segment elevation myocardial infarction:Understanding and addressing the global risk-treatment paradox.Clin Cardiol,2019,42(10):1028-1040.
- [33]李为民,臧雁翔.冠心病双联抗血小板治疗优化策略的思考.临床心血管病杂志,2018,34(10):943-945.