背景:对于非ST段抬高急性冠脉综合征(NSTE-ACS)患者,在最近的一项随机对照试验中,普拉格雷被推荐超过替格瑞洛,尽管需要更多的理由数据。这里,研究了P2Y12抑制剂对NSTE-ACS患者缺血和出血事件的影响.
方法:纳入NSTE-ACS患者的临床试验,提取了相关数据,并进行了网络荟萃分析。
结果:本研究包括11项研究中的37,268例NSTE-ACS患者。普拉格雷和替格瑞洛的任何终点均无显著差异,尽管在除心血管死亡以外的所有终点,普拉格雷的事件减少可能性均高于替格瑞洛.与氯吡格雷相比,普拉格雷与主要不良心血管事件(MACE)的风险降低相关(风险比[HR],0.84;95%CI,0.71-0.99)和心肌梗死(HR,0.82;95%CI,0.68-0.99),但不增加大出血的风险(HR,1.30;95%CI,0.97-1.74)。同样,与氯吡格雷相比,替格瑞洛与降低心血管死亡风险相关(HR,0.79;95%CI,0.66-0.94)和大出血风险增加(HR,1.33;95%CI,1.00-1.77;P=0.049)。对于主要疗效终点(MACE),普拉格雷显示事件减少的可能性最高(P=0.97),优于替格瑞洛(P=0.29)和氯吡格雷(P=0.24).
结论:普拉格雷和替格瑞洛在每个终点都有相当的风险,尽管普拉格雷成为降低主要疗效终点的最佳治疗方法的可能性最高.这项研究强调需要进一步研究以研究NSTE-ACS患者的最佳P2Y12抑制剂选择。
For patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), prasugrel was recommended over ticagrelor in a recent randomized controlled trial, although more data are needed on the rationale. Here, the effects of P2Y12 inhibitors on ischemic and bleeding events in patients with NSTE-ACS were investigated.
Clinical trials that enrolled patients with NSTE-ACS were included, relevant data were extracted, and a network meta-analysis was performed.
This study included 37,268 patients with NSTE-ACS from 11 studies. There was no significant difference between prasugrel and ticagrelor for any end point, although prasugrel had a higher likelihood of event reduction than ticagrelor for all end points except cardiovascular death. Compared with clopidogrel, prasugrel was associated with decreased risks of major adverse cardiovascular events (MACE) (hazard ratio [HR], 0.84; 95% CI, 0.71-0.99) and myocardial infarction (HR, 0.82; 95% CI, 0.68-0.99) but not an increased risk of major bleeding (HR, 1.30; 95% CI, 0.97-1.74). Similarly, compared with clopidogrel, ticagrelor was associated with a reduced risk of cardiovascular death (HR, 0.79; 95% CI, 0.66-0.94) and an increased risk of major bleeding (HR, 1.33; 95% CI, 1.00-1.77; P = .049). For the primary efficacy end point (MACE), prasugrel showed the highest likelihood of event reduction (P = .97) and was superior to ticagrelor (P = .29) and clopidogrel (P = .24).
Prasugrel and ticagrelor had comparable risks for every end point, although prasugrel had the highest probability of being the best treatment for reducing the primary efficacy end point. This study highlights the need for further studies to investigate optimal P2Y12 inhibitor selection in patients with NSTE-ACS.