A Meta-analysis Of The Efficacy And Safety Of A Novel P2Y12-ADP Receptor Antagonist Versus Clopidogrel In Patients With Acute Coronary Syndrome And Chronic Kidney Disease

Objective: To compare the efficacy and safety of the novel P2Y12-adenosine diphosphate receptor antagonist(PPA)and clopidogrel in patients with acute coronary syndrome(ACS)complicated with chronic kidney Disease(CKD).Methods: We searched Pub Med,Embase,Central,CBM,Wanfang,CNKI,VIP databases and domestic and foreign clinical trial registration websites by computer.Chinese and English clinical studies on the use of antiplatelet agents in patients with acute coronary syndrome complicated with chronic kidney disease were searched from the establishment of the database to December 2020.Relevant data were extracted and statistically analyzed using Review Manager(Rev Man5.3)software.Results: Relevant literatures were retrieved according to the combination of subject words and free words,and literature screening was conducted under the set inclusion criteria and exclusion criteria.finally,A total of two domestic randomized controlled trials,three subgroup analyses of foreign randomized clinical trials and four Cohort studies were included,It included 121,514 people.Through pooled effect size,the results suggested that aspirin combined with novel PPA was better than aspirin combined with clopidogrel in the prevention of secondary cardiovascular events in patients with ACS complicated with CKD stage 1-2(HR=0.85,95%CI :0.79-0.91,P < 0.00001),and either ticagrelor or pragurel seemed to be better for the prevention of secondary cardiovascular events in this population.in patients with ACS complicated with CKD stage 3,aspirin combined with the novel PPA was also better at preventing secondary cardiovascular events than aspirin combined with clopidogrel(HR=0.83,95%CI :0.76-0.92,P=0.0001),but in this population,ticagrelor may be a better choice.In patients with ACS complicated with CKD stage4-5,Compared aspirin combined with clopidogrel,Aspirin combined with the novel PPA did not reduce the incidence of recurrent cardiovascular events in this population(HR=0.90,95%CI :0.67-1.21,P=0.48).In patients with ACS complicated with CKD stage 1-3,the new PPA does not appear to increase the risk of bleeding compared to clopidogrel in each of the studies included in the analysis,although no convincing P values were obtained.In patients with ACS complicated with CKD stage 4-5,the answer was not very clear.Conclusions: Compared with clopidogrel,In patients with ACS complicated with CKD stage 1-2,either ticagrelor or prasugrel can reduced the risk of subsequent adverse cardiovascular events such as secondary myocardial infarction,stroke,or cardiovascular death.In patients with ACS with CKD stage 3,ticagrelor appears to be the better choice in reducing the risk of subsequent adverse cardiovascular events.More evidence is needed on the selection of novel PPA and clopidogrel in patients with ACS complicated with CKD stage 4-5.Care should be taken to assess the risk of bleeding in patients using the novel PPA.