Effectiveness and Safety of Platelet ADP–P2Y12 Receptor Inhibitors Influenced by Smoking Status: A Systematic Review and Meta‐Analysis
Effectiveness and Safety of Platelet ADP–P2Y12 Receptor Inhibitors Influenced by Smoking Status: A Systematic Review and Meta‐Analysis
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DOI：
10.1161/jaha.118.010889
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发表时间：
2019-03
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影响因子：
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通讯作者：
Zhiyan Liu;Q. Xiang;Guangyan Mu;Qiu-fen Xie;Shuang Zhou;Zi-ning Wang;Shu-qing Chen;Kun Hu;Y. Gong;Jie Jiang;Yi-min Cui
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作者：
Zhiyan Liu;Q. Xiang;Guangyan Mu;Qiu-fen Xie;Shuang Zhou;Zi-ning Wang;Shu-qing Chen;Kun Hu;Y. Gong;Jie Jiang;Yi-min Cui
背景吸烟作为重要的心血管危险因素对血小板ADP-P2Y12受体抑制剂影响的报道缺乏一致性，我们旨在评估吸烟状况对血小板ADP-P2Y12受体抑制剂的有效性和安全性。方法与结果检索了PubMed、Web of Science、EMBASE、临床试验和Cochrane图书馆从成立到2018年6月。在检索到的5076篇引文中，22项研究，包括163 011例接受或未接受经皮冠状动脉介入治疗的患者，被纳入meta分析。在随访的第一年，与不吸烟者相比，卒中和主要心血管不良事件发生率分别降低了18% （P=0.008）和26% （P=0.02）。在没有经皮冠状动脉介入治疗的吸烟患者中，卒中发生率降低20% (P=0.02)，主要不良心血管事件发生率降低34% （P=0.0001）。不同吸烟状态的普拉格雷、替格瑞和氯吡格雷的临床转归率无显著差异。目前吸烟者和非吸烟者在心肌梗死和出血事件发生率方面无显著差异。结论：当前吸烟者的主要不良心血管事件和卒中事件发生率低于不吸烟者，特别是在早期（1年）和未经皮冠状动脉介入治疗的患者中。然而，由于缺乏原始的调整数据，吸烟者悖论仍然需要考虑年龄等协变量的影响。因此，应根据不同的吸烟状况、患者状况和治疗时间点，考虑不同的风险-获益评估。
Background As reports on the influence of cigarette smoking, an important cardiovascular risk factor, on platelet ADP–P2Y12 receptor inhibitors lack consistency, we aimed to assess the effectiveness and safety of platelet ADP–P2Y12 receptor inhibitors influenced by smoking status. Methods and Results PubMed, Web of Science, EMBASE, Clinical Trials, and the Cochrane Library were searched from inception until June 2018. Among the 5076 citations retrieved, 22 studies, including 163 011 patients with or without percutaneous coronary intervention, were included for meta‐analysis. Compared with nonsmokers within the first year of follow‐up, the reductions of stroke and major adverse cardiovascular event rate were 18% (P=0.008) and 26% (P=0.02), respectively. A 20% reduction in stroke (P=0.02) and a 34% reduction in major adverse cardiovascular event (P=0.0001) rates were observed in smoking patients without percutaneous coronary intervention. No significant difference was observed in clinical outcome rates among prasugrel, ticagrelor, and clopidogrel in different smoking status. No significant difference was found in myocardial infarction and bleeding event incidence between current smokers and nonsmokers. Conclusions We concluded that current smokers had a lower incidence of major adverse cardiovascular events and stroke events than did nonsmokers, particularly in the early period (1 year) and among patients without percutaneous coronary intervention. However, because of the lack of original adjusted data, smoker's paradox still needs to consider the impact of age and other covariates. Thus, a differential risk‐benefit evaluation should be considered, according to different smoking status, patient conditions, and therapy time points.