Abbreviated ticagrelor based dual antiplatelet therapy in acute coronary syndrome: A systematic review and meta-analysis.

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine Pub Date : 2024-09-19 DOI:10.1016/j.carrev.2024.09.005

Wissam Harmouch, Ravi Thakker, Mirza Umair Khalid, Wissam Khalife, Neal Kleiman, Umamahesh Rangasetty, Waleed Tallat Kayani, Hani Jneid, Bashar Al-Hemyari, Ayman Elbadawi

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引用次数: 0

Abstract

Background: Few randomized clinical trials have evaluated the safety and efficacy of abbreviated ticagrelor based dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS); however, these trials were underpowered to detect differences in hard clinical outcomes.

Methods: A systematic search of MEDLINE, Cochrane, and Scopus databases was performed through June 2024, for trials that compared abbreviated (≤3-months) versus standard 12-months ticagrelor based DAPT in ACS. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular death, myocardial infarction, stent thrombosis, ischemic stroke, and major bleeding. Endpoints were measured at 12-months after DAPT initiation. Data were pooled using random-effects model. Effect measure utilized was risk ratio (RR). Heterogeneity was assessed via Chi-squared and Higgin's I² test. RevMan 5.0 (Cochrane Collaboration, Oxford, United Kingdom) was utilized to perform statistical analysis.

Results: Five trials were included in this analysis with 21,407 patients assessed. ULTIMATE-DAPT, T-PASS, and GLOBAL LEADERS-ACS assessed 1-month DAPT duration while TICO and TWILIGHT-ACS assessed 3-months DAPT duration. The average age was 62.7 years and 22.7 % were women. ACS presentations included non-ST elevation myocardial infarction (40.1 %), unstable angina (35.2 %), and ST-segment elevation myocardial infarction (31.5 %). Abbreviated ticagrelor based DAPT was associated with lower risk of all-cause mortality (RR 0.78; 95 % Confidence Interval (CI) 0.62-0.98, I² = 0 %) compared with standard duration DAPT. There was no difference between groups in cardiovascular death (RR 0.65; 95 % CI 0.41-1.03, I² = 0 %), myocardial infarction (RR 1.04; 95 % CI 0.85-1.27, I² = 0 %), stent thrombosis (RR 0.97; 95 % CI 0.64-1.45, I² = 0 %), or ischemic stroke (RR 0.90; 95 % CI 0.62-1.30, I² = 0 %). Abbreviated DAPT was associated with lower risk of major bleeding (RR 0.50; 95 % CI 0.38-0.66, I² = 46 %).

Conclusion: Our analysis includes the totality of randomized data evaluating the merits of abbreviated ticagrelor based DAPT after ACS. The salient study finding was the observed reduced risk of all-cause mortality and major bleeding with abbreviated DAPT approach.

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急性冠状动脉综合征中基于替卡格雷的简短双联抗血小板疗法：系统综述和荟萃分析。

背景：很少有随机临床试验对急性冠状动脉综合征（ACS）中基于替卡格雷的简短双联抗血小板疗法（DAPT）的安全性和有效性进行评估；然而，这些试验在检测硬性临床结果的差异方面动力不足：方法：对MEDLINE、Cochrane和Scopus数据库进行了系统检索，检索时间截止到2024年6月，目的是比较ACS中基于替卡格雷的简短（≤3个月）DAPT与基于替卡格雷的标准12个月DAPT的试验。主要终点是全因死亡率。次要终点包括心血管死亡、心肌梗死、支架血栓、缺血性中风和大出血。终点在 DAPT 开始后 12 个月进行测量。采用随机效应模型对数据进行汇总。采用风险比 (RR) 作为效果测量指标。异质性通过Chi-squared和Higgin's I2检验进行评估。使用 RevMan 5.0（Cochrane Collaboration，英国牛津）进行统计分析：本次分析共纳入了五项试验，评估了 21,407 名患者。ULTIMATE-DAPT、T-PASS和GLOBAL LEADERS-ACS评估了1个月的DAPT持续时间，而TICO和TWILIGHT-ACS评估了3个月的DAPT持续时间。平均年龄为 62.7 岁，22.7% 为女性。ACS表现包括非ST段抬高型心肌梗死（40.1%）、不稳定型心绞痛（35.2%）和ST段抬高型心肌梗死（31.5%）。与标准疗程的DAPT相比，基于替卡格雷的简短DAPT与较低的全因死亡风险相关（RR 0.78; 95 % 置信区间 (CI) 0.62-0.98, I2 = 0 %）。在心血管死亡（RR 0.65; 95 % CI 0.41-1.03, I2 = 0 %）、心肌梗死（RR 1.04; 95 % CI 0.85-1.27, I2 = 0 %）、支架血栓形成（RR 0.97; 95 % CI 0.64-1.45, I2 = 0 %）或缺血性中风（RR 0.90; 95 % CI 0.62-1.30, I2 = 0 %）方面，组间无差异。缩短DAPT与较低的大出血风险相关（RR 0.50; 95 % CI 0.38-0.66, I2 = 46 %）：我们的分析包括了评估ACS后基于替卡格雷的简短DAPT优点的全部随机数据。研究的突出发现是观察到简短DAPT方法降低了全因死亡率和大出血风险。

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

Cardiovascular Revascularization Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.30

自引率

5.90%

发文量

687

审稿时长

36 days

期刊介绍： Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.