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首页> 外文期刊>The American Journal of Cardiology >Meta-Analysis Comparing the Safety and Efficacy of Prasugrel and Ticagrelor in Acute Coronary Syndrome
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Meta-Analysis Comparing the Safety and Efficacy of Prasugrel and Ticagrelor in Acute Coronary Syndrome

机译：荟萃分析比较血清冠状动脉综合征中普拉布雷和TiCagreloR的安全性和疗效

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摘要

Prasugrel and ticagrelor are preferred over clopidogrel for patients with acute coronary syndrome who underwent percutaneous coronary intervention. We sought to determine the relative merits of 1 agent over the other. Multiple databases were queried to identify relevant randomized control trials (RCTs) and observational cohort studies. Random-effects model was used to calculate an unadjusted odds ratio (OR) for major adverse cardiovascular and cerbrovascular events (MACCE) and its components. A total of 27 (7 RCTs, 20 observational cohort studies) studies comprising 118,266 (prasugrel 62,716, ticagrelor 51,196) patients were included. At 30 days, prasugrel was associated with a significantly lower odds of MACCE (OR 0.75, 95% confidence interval [CI] 0.67 to 0.85, p <= 0.0001) and mortality (OR 0.65, 95% CI 0.59 to 0.71, p <= 0.0001). At 1 year, the overall odds of mortality favored prasugrel (OR 0.79, 95% CI 0.68 to 0.92, p = 0.002), but no significant interdrug difference was seen in terms of MACCE (OR 0.89, 95% CI 0.76 to 1.05, p = 0.16). There was no significant difference in the odds of overall myocardial infarction, revascularization, stent thrombosis, stroke, and major bleeding events between the 2 groups on both 30-day and 1-year follow-up. A subgroup analysis of RCTs data showed no significant difference between prasugrel and ticagrelor in terms of any end point at all time points. In conclusion, prasugrel might have lower odds of MACCE and mortality at 30 days. However, there was no difference in the safety and efficacy end points of 2 drugs at 1 year. The observed transient prasugrel-related mortality benefits were subject to the bias of nonrandomized assignment. (C) 2020 Elsevier Inc. All rights reserved.
机译：对于接受经皮冠状动脉介入治疗的急性冠状动脉综合征患者，普拉格雷和替卡格雷优于氯吡格雷。我们试图确定一种药剂相对于另一种药剂的相对优点。查询多个数据库以确定相关的随机对照试验（RCT）和观察性队列研究。随机效应模型用于计算主要心血管和心血管不良事件（MACCE）及其组分的未调整优势比（OR）。共纳入27项研究（7项随机对照试验，20项观察性队列研究），包括118266名（普拉格雷62716名，替卡格雷51196名）患者。30天时，普拉格雷与MACCE（OR 0.75，95%可信区间[CI]0.67至0.85，p<=0.0001）和死亡率（OR 0.65，95%可信区间0.59至0.71，p<=0.0001）显著降低相关。在1年时，总体死亡率倾向于普拉格雷（OR 0.79，95%可信区间0.68至0.92，p=0.002），但在MACCE方面未发现显著的药物间差异（OR 0.89，95%可信区间0.76至1.05，p=0.16）。在30天和1年的随访中，两组总的心肌梗死、血运重建、支架血栓形成、卒中和主要出血事件的发生率没有显著差异。对随机对照试验数据的亚组分析显示，普拉格雷和替卡格雷在所有时间点的任何终点均无显著差异。总之，普拉格雷在30天时发生MACCE和死亡率可能较低。然而，两种药物在1年时的安全性和有效性终点没有差异。观察到的与普拉格雷相关的短暂死亡率益处受非随机分配的偏差影响。（C） 2020爱思唯尔公司版权所有。

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