[1]周锐 赵飞飞 钱阳 余文静 王大新..氯吡格雷与替格瑞洛的安全性和有效性在东亚急性心肌梗死患者的比较：系统回顾和荟萃分析[J].心血管病学进展,2021,(6):560.[doi:10.16806/j.cnki.issn.1004-3934.2021.06.020]
　ZHOU RuiZHAO Feifei QIAN YangYU WenjingWANG Daxin.Comparison of the Safety and Efficacy of Clopidogrel Versus Ticagrelor in Patients with Acute Myocardial Infarction in East Asia:a Systematic Review and Meta-Analysis[J].Advances in Cardiovascular Diseases,2021,(6):560.[doi:10.16806/j.cnki.issn.1004-3934.2021.06.020]
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氯吡格雷与替格瑞洛的安全性和有效性在东亚急性心肌梗死患者的比较：系统回顾和荟萃分析()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2021年6期
页码:
560
栏目:
论著
出版日期:
2021-06-25

文章信息/Info

Title:
Comparison of the Safety and Efficacy of Clopidogrel Versus Ticagrelor in Patients with Acute Myocardial Infarction in East Asia:a Systematic Review and Meta-Analysis
作者:
周锐1 赵飞飞2 钱阳1 余文静1 王大新1.2
(1.大连医科大学研究生院,辽宁 大连 116000;2.扬州大学附属苏北人民医院心内科,江苏 扬州 225000)
Author(s):
ZHOU Rui1ZHAO Feifei 2QIAN Yang1YU Wenjing1WANG Daxin1; 2
Graduate School of Dalian Medical University,Dalian 116000 ,Liaoning,China;2.Department of Cardiology,Northern Jiangsu People’s Hospital Affiliated to Yangzhou University,Yangzhou 225000, Jiangsu,China)
关键词:
替格瑞洛; 氯吡格雷; 急性冠脉综合征; 东亚
Keywords:
Ticorrello; Clopidogrel; Acute coronary syndrome; East Asia
DOI:
10.16806/j.cnki.issn.1004-3934.2021.06.020
摘要:
目的 本次荟萃分析是为了更好地评价替格瑞洛与氯吡格雷相比在东亚急性冠脉综合征患者中的作用。方法 使用常用的在线检索数据库（Cochrane library、Pubmed、Medline）检索相关文献。主要终点为不良心血管事件，次要结果是出血事件。该分析采用RevMan 5.3进行，以RR和95%CI作为统计参数。结果 这项分析包括8项研究，共30 366例参与者。基于我们的研究结果，替格瑞洛主要疗效终点风险（定义为血管死因、心肌梗死或中风的复合死亡）的数值较低（无统计学意义）（RR 1.12，95%CI 0.78~1.62，I2=55%，P=0.09）。主要心血管不良事件、卒中和心肌梗死发生率显著降低，替格瑞洛优于氯吡格雷（RR 1.38，95%CI 1.05~1.80，I2=59%，P<0.02；RR 1.46，95%CI 1.16~1.85，P<0.02，I2=1%；RR 1.15，95%CI 1.01~1.31，P=0.03，I2=28%)。此外，与氯吡格雷相比，替格瑞洛主要出血事件及全因死亡率并无统计学意义（RR 1.12，95%CI 0.78-1.62，P=0.53，I2=54%；RR 1.37，95%CI 0.89-2.11，P=0.16，I2=82%）。结论 荟萃分析表明，在东亚急性冠脉综合征患者中，替格瑞洛明显优于氯吡格雷，经皮冠状动脉介入治疗后全因死亡率、主要心血管不良事件和卒中显著降低。替格瑞洛与氯吡格雷相比，两者主要出血风险并无差异。
Abstract:
Objective The purpose of this meta-analysis was to better evaluate the effect of Ticagrello versus clopidogrel in patients with ACS in East Asia.Methods Relevant literatures were searched using the commonly used online retrieval databases (Cochrane Library,Pubmed,Medline).The primary end point was adverse cardiovascular events.Secondary outcomes are hemorrhagic events.The analysis was performed using RevMan 5.3,with RR and 95% CI as statistical parameters。 Results The analysis included eight studies with a total of 30,366 participants.Based on our results,the risk of primary outcome points (defined as vascular cause of death,combined death from myocardial infarction or stroke) was low (no statistical significance) (RR 1.12,95%CI 0.78~1.62,I2=55%,P=0.09).Major adverse cardiovascular events,strokeand myocardial infarction were significantly reduced,and Ticagrelor was superior to clopidogrel (RR 1.38,95%CI 1.05~1.80,I2=59%,P<0.02;RR 1.46,95%CI 1.16 ~1.85,P<0.02,I2=1%;RR 1.15,95%CI 1.01~1.31,P=0.03,I2=28%).In addition,compared with clopidogrel,there was no statistically significant difference in major bleeding events and all-cause mortality (RR 1.12,95%CI 0.78-1.62,P=0.53,I2=54%;RR 1.37,95%CI 0.89-2.11,P=0.16,I2=82%). Conclusion Meta-analysis showed that ticagrelor was significantly superior to clopidogrel in patients with East Asian acute coronary syndrome, with significant reductions in all-cause mortality, major cardiovascular adverse events, and stroke after percutaneous coronary intervention.There was no difference in the major bleeding risk between ticagrelor and clopidogrel

参考文献/References:

[1] Chan MY,Du X,Eccleston D,et al.Acute coronary syndrome in the Asia-Pacific region[J].Int J Cardiol,2016,202:861-869.

[2] 胡盛寿,高润霖,刘力生,等.《中国心血管病报告2018》概要[J].中国循环杂志,2019,34(3):209-220.

[3] Storey RF,Husted S,Harrington RA,et al.Inhibition of platelet aggregation by AZD6140,a reversible oral P2Y12 receptor antagonist,compared with clopidogrel in patients with acute coronary syndromes[J].J Am Coll Cardiol,2007,50(19):1852-1856.

[4] Wallentin L,Becker RC,Budaj A,et al.Ticagrelor versus clopidogrel in patients with acute coronary syndromes[J].N Engl J Med,2009,361(11):1045-1057.

[5] Wang TY,Chen AY,Roe MT,et al.Comparison of baseline characteristics,treatment patterns,and in-hospital outcomes of Asian versus non-Asian white Americans with non-ST-segment elevation acute coronary syndromes from the CRUSADE quality improvement initiative[J].Am J Cardiol,2007,100(3):391-396.

[6] Misumida N,Ogunbayo GO,Kim SM,et al.Higher risk of bleeding in Asians presenting with ST-segment elevation myocardial infarction: analysis of the national inpatient sample database[J].Angiology,2018,69(6):548-554.

[7] Deng M,Li H,Shi M,et al.Prevalence of acute coronary heart disease among farmers in Panyu,Guangzhou:a 20-year population-based study[J].Zhonghua Xin Xue Guan Bing Za Zhi,2014,42(3):236-240.

[8] Misumida N,Ogunbayo GO,Kim SM,et al.Higher risk of bleeding in Asians presenting with non-ST-segment elevation myocardial infarction[J].Angiology,2018,69(6):555-556.

[9] Mehran R,Pocock SJ,Nikolsky E,et al.A risk score to predict bleeding in patients with acute coronary syndromes[J].J Am Coll Cardiol,2010,55(23):2556-2566.

[10] Wu B,Lin H,Tobe RG,et al.Ticagrelor versus clopidogrel in East-Asian patients with acute coronary syndromes: a meta-analysis of randomized trials[J].J Comp Eff Res,2018,7(3):281-291.

[11] Chen I,Lee C,Fang C,et al.Efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome in Taiwan:a multicenter retrospective pilot study [J].J Chin Med Assoc,2016,79(10):521-530.

[12] Choe JC,Cha KS,Ahn J,et al.Comparison of prescription rates and clinical outcomes in acute coronary syndrome patients who underwent percutaneous coronary intervention using different P2Y inhibitors in a large observational study[J].Int J Cardiol,2019,274:21-26.

[13] Goto S,Huang C,Park S,et al.Ticagrelor vs clopidogrel in Japanese,Korean and Taiwanese patients with acute coronary syndrome -- randomized,double-blind,phase ⅢPHILO study[J].Circ J,2015,79(11):2452-2460.

[14] Kang H,Clare RM,Gao R,et al.Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome:a retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial[J].Am Heart J,2015,169(6):889-905.

[15] Lee C,Cheng C,Kao Yang Y,et al.Cardiovascular and bleeding risks in acute myocardial infarction newly treated with ticagrelor vs clopidogrel in Taiwan[J].Circ J,2018,82(3):747-756.

[16] Park D,Kwon O,Jang J,et al.Clinically significant bleeding with ticagrelor versus clopidogrel in korean patients with acute coronary syndromes intended for invasive management: a randomized clinical trial[J].Circulation,2019,140(23):1865-1877.

[17] Sun Y,Li C,Zhang L,et al.Clinical outcomes after ticagrelor and clopidogrel in Chinese post-stented patients[J].Atherosclerosis,2019,290:52-58.

[18] Wang H,Wang X.Efficacy and safety outcomes of ticagrelor compared with clopidogrel in elderly Chinese patients with acute coronary syndrome[J].Ther Clin Risk Manag,2016,12:1101-1105.

[19] Giordana F,Montefusco A,D’Ascenzo F,et al.Safety and effectiveness of the new P2Y12r inhibitor agents vs clopidogrel in ACS patients according to the geographic area: East Asia vs Europe[J].Int J Cardiol,2016,220:488-495.

[20] Park K,Jeong MH,Ahn Y,et al.Comparison of short-term clinical outcomes between

ticagrelor versus clopidogrel in patients with acute myocardial infarction undergoing successful revascularization; from Korea Acute Myocardial Infarction Registry-National Institute of Health[J].Int J Cardiol,2016,215:193-200.

[21] Kwon TJ,Tantry US,Park Y,et al.Influence of platelet reactivity on BARC classification in East Asian patients undergoing percutaneous coronary intervention.Results of the ACCEL-BLEED study[J].Thromb Haemost,2016,115(5):979-992.

[22] Ikemura N,Kohsaka S,Kimura T,et al.Assessment of sex differences in the initial symptom burden,applied treatment strategy,and quality of life in japanese patients with atrial fibrillation[J].JAMA Netw Open,2019,2(3):e191145.

[23] Cho H,Kang J,Kim HS,et al.Ethnic differences in oral antithrombotic therapy[J].Korean Circ J,2020,50(8):645-657.

[24] Sasaki J,Ikeda Y,Kuribayashi T,et al.A 52-week,randomized,open-label,parallel-group comparison of the tolerability and effects of pitavastatin and atorvastatin on high-density lipoprotein cholesterol levels and glucose metabolism in Japanese patients with elevated levels of low-density lipoprotein cholesterol and glucose intolerance[J].Clin Ther,2008,30(6):1089-1101.

[25] Chen Q,Zhang Y,Wang Z,et al.Efficacy and safety of low dose ticagrelor in patients with acute coronary syndrome: a systematic review and meta-analysis[J].Postgrad Med J,2020,96(1141):693-702.

[26] Park D,Lee PH,Jang S,et al.Effect of low-dose versus standard-dose ticagrelor and clopidogrel on platelet inhibition in acute coronary syndromes[J].J Am Coll Cardiol,2018,71(14):1594-1595.

[27] Bonaca MP,Bhatt DL,Cohen M,et al.Long-term use of ticagrelor in patients with prior myocardial infarction[J].N Engl J Med,2015,372(19):1791-1800.

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更新日期/Last Update: 2021-07-23