医学
传统PCI
经皮冠状动脉介入治疗
内科学
狼牙棒
随机对照试验
临床终点
阿司匹林
急性冠脉综合征
子群分析
氯吡格雷
荟萃分析
心肌梗塞
作者
Mattía Galli,Renzo Laborante,G. Occhipinti,Anna Zito,Luigi Spadafora,Giuseppe Biondi-Zoccai,Roberto Nerla,Fausto Castriota,Domenico D’Amario,Davide Capodanno,Young Hoon Jeong,Takeshi Kimura,Roxana Mehran,Dominick J. Angiolillo
出处
期刊:European Heart Journal - Cardiovascular Pharmacotherapy
[Oxford University Press]
日期:2023-11-13
被引量:3
标识
DOI:10.1093/ehjcvp/pvad085
摘要
Randomized controlled trials (RCTs) testing bleeding reduction strategies using antiplatelet treatment regimens (BRATs) in acute coronary syndromes (ACS) have shown promising results, but the generalizability of these findings may be significantly influenced by the ethnicity of the patients enrolled, given that East Asian (EA) patients show different ischemic-bleeding risk profile compared to non-EA patients.RCTs comparing a BRATs versus standard 12-month dual antiplatelet therapy (DAPT) in patients with ACS undergoing percutaneous coronary intervention (PCI) were selected. The primary efficacy endpoint was major adverse cardiovascular events (MACE) as defined in each trial and the primary safety endpoint was minor or major bleeding. Twenty-six RCTs testing seven different BRATs were included. The only strategy associated with a trade-off in MACE was "upfront unguided de-escalation" in the subgroup of non-EAs (RR 1.16, 95% CI 1.09-1.24). All but aspirin monotherapy-based strategies (i.e., "short and very short DAPT followed by aspirin") were associated with reduced bleeding compared with standard DAPT in both EA and non-EA patients. There were no significant differences between subgroups, but the lack of RCTs in some of the included strategies and the difference in the certainty of evidence between EA or non-EA patients revealed that the evidence in support of different BRATs in ACS undergoing PCI is influenced by ethnicity. Moreover, absolute risk reduction estimation revealed that some BRATs might be more effective than others in reducing bleeding according to ethnicity.The majority of BRATs are associated with reduced bleeding without any trade-off in hard ischemic endpoints regardless of ethnicity. However, the supporting evidence and relative safety profiles of different BRATs might be significantly affected by ethnicity, which should be taken into account in clinical practice. Study registration This study is registered in PROSPERO (CRD42023416710).
科研通智能强力驱动
Strongly Powered by AbleSci AI