Ticagrelor monotherapy after short duration of dual antiplatelet therapy compared to continued dual antiplatelet therapy in patients with acute coronary syndromes undergoing percutaneous coronary interventions: an updated meta-analysis.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Coronary artery disease Pub Date : 2024-11-01 Epub Date: 2024-08-23 DOI:10.1097/MCA.0000000000001417

Zeeshan Mansuri, Hadiah Ashraf, Thahsin Taikadan, Gokul Rajith, Ayesha Ayesha, Urooj Fatima, Gabriel Erzinger

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引用次数: 0

Abstract

Background: The optimum duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS) remains controversial. Ticagrelor monotherapy after short duration of DAPT (1-3 months) is a subject of research. We conducted an updated systematic review and meta-analysis comparing the ticagrelor monotherapy with continued DAPT after short duration of DAPT in patients with ACS undergoing PCI.

Methods: PubMed, Embase, and Cochrane databases were searched for studies comparing ticagrelor monotherapy to DAPT after PCI and reported the outcomes of major adverse cardiovascular and cerebrovascular events (MACCE); net adverse clinical events (NACE); myocardial infarction (MI); major bleeding; death from any cause; definite or probable stent thrombosis; and target vessel revascularization (TVR). Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Statistical analysis was performed using Review Manager (Cochrane collaboration). Heterogeneity was examined with I2 test.

Results: Of 3,208 results, five studies with 21,407 patients were included of which 50% received ticagrelor monotherapy. Studies had reported follow up of 12 months. Major bleeding [hazard ratio 0.47; 95% confidence interval (CI), 0.37-0.61; P < 0.001], NACE (hazard ratio 0.71; 95% CI, 0.56-0.90; P = 0.005), and all-cause death (hazard ratio 0.76; 95% CI, 0.59-0.98; P = 0.04) were significantly less with ticagrelor monotherapy. Other outcomes were comparable in both groups.

Conclusion: In patients with ACS undergoing PCI, ticagrelor monotherapy reduces major bleeding, NACE and all-cause death as compared to continued DAPT for 12 months. Major ischemic outcomes were similar. Ticagrelor monotherapy is the way forward after short duration of DAPT after PCI in ACS.

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在接受经皮冠状动脉介入治疗的急性冠状动脉综合征患者中，短期双联抗血小板疗法后的替卡格雷单药治疗与持续双联抗血小板疗法的比较：最新荟萃分析。

背景：急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）后双联抗血小板疗法（DAPT）的最佳疗程仍存在争议。DAPT持续时间较短（1-3个月）后的替卡格雷单药治疗是一个研究课题。我们进行了一项最新的系统综述和荟萃分析，比较了在接受 PCI 治疗的 ACS 患者中，DAPT 持续时间较短后，替卡格雷单药治疗与持续 DAPT 治疗的效果：在PubMed、Embase和Cochrane数据库中检索了PCI术后替卡格雷单药治疗与DAPT的比较研究，并报告了主要不良心脑血管事件（MACCE）、净不良临床事件（NACE）、心肌梗死（MI）、大出血、任何原因导致的死亡、明确或可能的支架血栓形成以及靶血管血运重建（TVR）的结果。从已发表的报告中提取数据，并根据 Cochrane 建议进行质量评估。统计分析使用Review Manager（Cochrane协作）进行。异质性采用I2检验：在 3208 项研究结果中，有 5 项研究纳入了 21 407 例患者，其中 50%接受了替卡格雷单药治疗。研究报告的随访时间为 12 个月。大出血[危险比为0.47；95%置信区间（CI）为0.37-0.61；P 结论：在接受PCI治疗的ACS患者中，大出血的危险比为0.47：对于接受 PCI 治疗的 ACS 患者，与持续 12 个月的 DAPT 相比，替卡格雷单药治疗可减少大出血、NACE 和全因死亡。主要缺血性结果相似。在 ACS 患者接受 PCI 后短期 DAPT 后，替卡格雷单药治疗是未来的发展方向。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.