背景:关于冠状动脉疾病(CAD)经皮冠状动脉介入治疗(PCI)后双重抗血小板治疗(DAPT)的最佳持续时间仍存在争议。最近的试验引入了一种新的方法,涉及替格瑞洛或氯吡格雷的P2Y12抑制剂单药治疗,在短暂的DAPT之后。然而,该策略的有效性和安全性仍有待确定。我们旨在进行一项荟萃分析,比较P2Y12抑制剂单药治疗与标准DAPT在接受PCI12个月时的疗效。
方法:检索了多个数据库。包括六个RCTs,总共24877名患者。主要终点是随访12个月时的全因死亡率。次要终点是心血管死亡率,心肌梗塞,可能或明确的支架内血栓形成,卒中事件,大出血.该研究在PROSPERO(CRD42024499529)注册。
结果:使用P2Y12抑制剂替格瑞洛的单药治疗可显著降低两种全因死亡率(HR0.71,95CI[0.55-0.91],P=0.007)和心血管死亡率(HR0.66,95%CI[0.49-0.89],P=0.006)与标准DAPT相比。相比之下,氯吡格雷单药治疗未显示类似的减少.与替格瑞洛相关的死亡率下降主要是由于大出血风险较低(HR0.56,95%CI[0.43-0.72],P<0.001),而心肌梗死(MI)的风险保持不变(HR0.90,95%CI[0.73-1.11],P=0.32)。发现中风的风险在治疗中相似。
结论:与标准DAPT相比,P2Y12抑制剂单药治疗替格瑞洛可能导致死亡率降低。临床益处是由出血风险的降低而没有缺血性风险权衡驱动的。
BACKGROUND: Debates persist regarding the optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in coronary artery disease (CAD). Recent trials have introduced a novel approach involving
P2Y12 inhibitor monotherapy with ticagrelor or clopidogrel, after a short DAPT. However, the effectiveness and safety of this strategy remains to be established. We aimed to perform a meta-analysis comparing monotherapy with
P2Y12 inhibitors versus standard DAPT in patients undergoing PCI at 12 months.
METHODS: Multiple databases were searched. Six RCTs with a total of 24877 patients were included. The primary endpoint was all-cause mortality at 12 months of follow-up. The secondary endpoints were cardiovascular mortality, myocardial infarction, probable or definite stent thrombosis, stroke events, and major bleeding. The study is registered with PROSPERO (CRD42024499529).
RESULTS: Monotherapy with
P2Y12 inhibitor ticagrelor significantly reduced both allcause mortality (HR 0.71, 95 CI [0.55-0.91], P = 0.007) and cardiovascular mortality (HR 0.66, 95% CI [0.49-0.89], P = 0.006) compared to standard DAPT. In contrast, clopidogrel monotherapy did not demonstrate a similar reduction. The decrease in mortality associated with ticagrelor was primarily due to a lower risk of major bleeding (HR 0.56, 95% CI [0.43-0.72], P < 0.001), while the risk of myocardial infarction (MI) remained unchanged (HR 0.90, 95% CI [0.73-1.11], P = 0.32). The risk of stroke was found to be similar across treatments.
CONCLUSIONS: In comparison to standard DAPT,
P2Y12 inhibitor monotherapy with ticagrelor may lead to a reduced mortality. The clinical benefits are driven by a reduction of bleeding risk without ischemic risk trade-off.