Purpose

Effective platelet inhibition prior to elective percutaneous coronary intervention (PCI) reduces the risk of ischemic complications. Newer P2Y12 inhibitors are preferred agents over clopidogrel for patients presenting with the acute coronary syndrome. However, the comparative efficacy and safety of them over clopidogrel in elective PCI is unclear. We performed a network meta-analysis to compare the safety and efficacy of loading strategies of P2Y12 inhibitors in patients undergoing elective PCI.

Methods

We conducted a systematic review of randomized controlled trials (RCT) up to June 2021 to compare the safety and effectiveness of different loading strategies of P2Y12 inhibitors before elective PCI. The endpoints of interest were overall mortality, rates of myocardial infarction (MI), stroke, revascularization, and major bleeding. Random effects model using the frequentist approach was used to perform a network meta-analysis using R software.

Results

Five trials with a total of 5194 patients were included in our analysis. For ischemic outcomes, including MI, stroke, and revascularization, prasugrel had the most favorable trend. However, clopidogrel had the highest probability of being most effective for major bleeding and all-cause mortality. None of these trends was statistically significant due to lack of power for each outcome.

Conclusion

Although prasugrel and ticagrelor are known as more potent antiplatelet agents, their effects in preventing MI and stroke are marginal and do not translate into improved overall mortality and bleeding compared with clopidogrel.

中文翻译：

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接受选择性 PCI 的患者 P2Y12 抑制剂负荷剂量的比较安全性和有效性：网络荟萃分析

目的

选择性经皮冠状动脉介入治疗 (PCI) 前有效的血小板抑制可降低缺血性并发症的风险。对于出现急性冠状动脉综合征的患者，较新的 P2Y12 抑制剂是优于氯吡格雷的首选药物。然而，它们在择期 PCI 中与氯吡格雷相比的疗效和安全性尚不清楚。我们进行了一项网络荟萃分析，以比较 P2Y12 抑制剂负荷策略在接受择期 PCI 的患者中的安全性和有效性。

方法

We conducted a systematic review of randomized controlled trials (RCT) up to June 2021 to compare the safety and effectiveness of different loading strategies of P2Y12 inhibitors before elective PCI. The endpoints of interest were overall mortality, rates of myocardial infarction (MI), stroke, revascularization, and major bleeding. Random effects model using the frequentist approach was used to perform a network meta-analysis using R software.

Results

Five trials with a total of 5194 patients were included in our analysis. For ischemic outcomes, including MI, stroke, and revascularization, prasugrel had the most favorable trend. However, clopidogrel had the highest probability of being most effective for major bleeding and all-cause mortality. None of these trends was statistically significant due to lack of power for each outcome.

Conclusion

尽管普拉格雷和替格瑞洛被认为是更有效的抗血小板药物，但它们在预防 MI 和中风方面的作用微乎其微，与氯吡格雷相比，它们并没有转化为总体死亡率和出血的改善。