Long-term Clinical Efficacy And Safety Of Ticagrelor Versus Clopidogrel In Patients With Acute Coronary Syndrome After Percutaneous Coronary Intervention:A Meta-analysis

Objective: Meta-analysis was used to evaluate the efficacy of dual-antiplatelet therapy(DAPT)between ticagrelor and clopidogrel plus aspirin in patients with acute coronary syndrome(ACS)after long-term percutaneous coronary intervention(PCI)effectiveness and safety,providing evidence for clinical practice.Methods: Acute coronary syndrome(ACS),ST-segment elevation myocardial infarction(STEMI),non-ST-segment elevation myocardial infarction(NSTEMI),unstable angina(UA),non-ST-segment elevation acute coronary artery Syndrome(NSTE-ACS),percutaneous coronary intervention(PCI),clopidogrel and ticagrelor were the Me SH words for literature search.Seven databases(Pubmed,the Cochrane Library,Embase,CNKI,VIP,CMB and Wanfang)were systematically searched about the long-term(≥ 6 months)efficacy and safety of DAPT after PCI in patients with ACS from their inception to September 2018.RCTs which evaluates the long-term efficacy and safety of clopidogrel versus ticagrelor in DAPT after PCI in patients with ACS were included,according to the inclusion and exclusion criteria.A meta-analysis was performed using Review Manager 5.3 software after the quality evaluation of literature.Results: 46 RCTs(12361 participants)were included in this meta-analysis,including 6114 participants in the observation group and 6247 articipants in the control group.1.Compared with clopidogrel,ticagrelor combined with aspirin in DAPT significantly reduces the incidence of major adverse cardiovascular events(MACE)[RR = 0.58,95% Cl(0.51,0.65),p < 0.00001],the recurrence rate of angina pectoris [RR = 0.47,95% Cl(0.35,0.63),p < 0.00001],the recurrence rate of myocardial infarction [RR = 0.40,95% Cl(0.29,0.57),p < 0.00001] and the incidence of stent thrombosis [RR = 0.49,95% Cl(0.38,0.63),p < 0.00001].Moreover,it reduces the risk of cardiogenic death [RR = 0.76,95% Cl(0.60,0.97),p = 0.03],the risk of repeat revascularization [RR = 0.66,95% Cl(0.50,0.86),p = 0.002] and the risk of heart failure [RR = 0.65,95% Cl(0.48,0.89),p = 0.02].However,there is no significant difference in the incidence of all-cause mortality [RR = 0.85,95% Cl(0.67,1.09),p = 0.20] and the incidence of stroke [RR = 1.08,95% Cl(0.67,1.75),p = 0.75].2.Compared with clopidogrel in combination with aspirin,ticagrelor combined with aspirin in DAPT significantly increases the risk of total bleeding events [RR = 1.30,95% Cl(1.14,1.49),p = 0.0001].Moreover,it increases the risk of secondary bleeding events [RR = 1.87,95% Cl(1.18,2.97),p = 0.008]] and the risk of minor bleeding events [RR = 1.62,95% Cl(1.17,2.25),p = 0.004].However,the risk of major bleeding events [RR=0.87,95%Cl(0.45,1.53),p = 0.55] and the risk of gastrointestinal bleeding events [RR = 2.03,95% Cl(0.95,4.83),p = 0.07] has no significant increase.3.Compared with clopidogrel in combination with aspirin,ticagrelor combined with aspirin in DAPT significantly increases the risk of dyspnea in patients [RR = 3.14,95% Cl(2.18,5.53),p < 0.00001].Conclusion:In patients with ACS,dual antiplatelet therapy was used for more than 6 months after PCI,and ticagrelor plus aspirin was superior to clopidogrel plus aspirin.