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Background: The efficacy and safety of novel oral P2Y12 receptor inhibitors (prasugrel and ticagrelor) are subjects of contention in ST-segment elevation myocardial infarction (STEMI) patients undergoing PCI, the optimal duration of therapy remains uncertain.
Methods: We searched PubMed, Embase, Cochrane Library, CNKI, VIP, and WanFang Data to identify randomized controlled trials comparing novel oral P2Y12 receptor inhibitors to clopidogrel in STEMI patients undergoing PCI until February 2016. The primary efficacy and safety endpoint were all-cause mortality and major/minor bleeding.
Results: Twelve studies were included. Novel oral P2Y12 inhibitors significantly reduced the incidence of all-cause death (relative risk [RR]: 0.65, 95 % CI: 0.53 – 0.78), MACE (0.68 [0.56 – 0.83]) and stent thrombosis (0.56 [0.43 – 0.75]) without significant difference in bleeding (P = 0.20) compared with clopidogrel. Identical results were observed in the longer dual antiplatelet therapy (DAPT) and shorter-DAPT subgroups, albeit Chinese patients with ticagrelor treatment had a slight increase in bleeding (P = 0.08). Furthermore, the pooled RR ratio for each endpoint showed no significant difference between the longer-DAPT and shorter-DAPT subgroups.
Conclusions: STEMI patients undergoing PCI who received novel oral P2Y12 receptor inhibitors had significant reductions in the risk of all-cause death, MACE, and stent thrombosis without causing more bleeding events compared with clopidogrel.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Antiplatelet and Antithrombotic Agents in Ischemic Heart Disease
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1296-307
- 2017 American College of Cardiology Foundation