Comparative Efficacy and Safety of Oral P2Y12 Inhibitors in Acute Coronary Syndrome Network Meta-Analysis of 52 816 Patients From 12 Randomized Trials
Comparative Efficacy and Safety of Oral P2Y12 Inhibitors in Acute Coronary Syndrome Network Meta-Analysis of 52 816 Patients From 12 Randomized Trials
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DOI：
10.1161/circulationaha.120.046786
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发表时间：
2020-07-14
期刊：
影响因子：
37.8
通讯作者：
James, Stefan
中科院分区：
文献类型：
--
作者：
Navarese, Eliano P.;Khan, Safi U.;James, Stefan
背景：关于口服P2 Y（12）抑制剂治疗急性冠脉综合征的新的随机对照试验已经出现。我们的目的是通过随机对照试验的荟萃分析来评估比较普拉格雷、替格瑞洛和氯吡格雷在急性冠脉综合征中的疗效和安全性的现有证据。方法：我们对12项随机对照试验的疗效和安全性结果进行了网络荟萃分析和直接成对比较分析，共包括52816例急性冠脉综合征患者。结果：与氯吡格雷相比，替格瑞洛显著降低了心血管死亡率（风险比[HR]，0.82 [95% CI，0.72-0.92]）和全因死亡率（HR，0.83 [95%CI，0.75-0.92]），而普拉格雷没有统计学显著的死亡率降低（HR分别为0.90 [95% CI，0.80-1.01]和0.92 [95% CI，0.84-1.02]）。相互比较，死亡率无显著差异（HR普拉格雷vs替格瑞洛，1.10 [95% CI，0.94-1.29]和1.12 [95% CI，0.98-1.28]）。与氯吡格雷相比，普拉格雷降低了心肌梗死风险（HR，0.81 [95% CI，0.67-0.98]），而替格瑞洛未显示风险降低（HR，0.97 [95% CI，0.78-1.22]）。普拉格雷和替格瑞洛之间的差异无统计学意义。与氯吡格雷相比，替格瑞洛和普拉格雷均显著降低了支架血栓形成风险（降低范围为28%-50%）。与氯吡格雷相比，普拉格雷（HR，1.26 [95% CI，1.01-1.56]）和替格瑞洛（HR，1.27 [95% CI，1.04-1.55]）均显著增加大出血。普拉格雷和替格瑞洛之间没有显着差异的所有outcomesexplored.Conclusions：普拉格雷和替格瑞洛减少缺血性事件和增加出血与氯吡格雷相比。仅用替格瑞洛观察到显著的死亡率降低。普拉格雷和替格瑞洛之间没有疗效和安全性差异。
Background: New randomized, controlled trials have become available on oral P2Y(12)inhibitors in acute coronary syndrome. We aimed to evaluate current evidence comparing the efficacy and safety profile of prasugrel, ticagrelor, and clopidogrel in acute coronary syndrome by a meta-analysis of randomized controlled trials.Methods: We performed a network meta-analysis and direct pairwise comparison analysis of efficacy and safety outcomes from 12 randomized controlled trials including a total of 52 816 patients with acute coronary syndrome.Results: In comparison with clopidogrel, ticagrelor significantly reduced cardiovascular mortality (hazard ratio [HR], 0.82 [95% CI, 0.72-0.92]) and all-cause mortality (HR, 0.83 [95% CI, 0.75-0.92]), whereas there was no statistically significant mortality reduction with prasugrel (HR, 0.90 [95% CI, 0.80-1.01] and HR, 0.92 [95% CI, 0.84-1.02], respectively). In comparison with each other, there were no significant differences in mortality (HR prasugrel versus ticagrelor, 1.10 [95% CI, 0.94-1.29] and 1.12 [95% CI, 0.98-1.28]). In comparison with clopidogrel, prasugrel reduced myocardial infarction (HR, 0.81 [95% CI, 0.67-0.98]), whereas ticagrelor showed no risk reduction (HR, 0.97 [95% CI, 0.78-1.22]). Differences between prasugrel and ticagrelor were not statistically significant. Stent thrombosis risk was significantly reduced by both ticagrelor and prasugrel versus clopidogrel (28%-50% range of reduction). In comparison with clopidogrel, both prasugrel (HR, 1.26 [95% CI, 1.01-1.56]) and ticagrelor (HR, 1.27 [95% CI, 1.04-1.55]) significantly increased major bleeding. There were no significant differences between prasugrel and ticagrelor for all outcomes explored.Conclusions: Prasugrel and ticagrelor reduced ischemic events and increased bleeding in comparison with clopidogrel. A significant mortality reduction was observed with ticagrelor only. There was no efficacy and safety difference between prasugrel and ticagrelor.