P2Y12抑制劑單藥療法二級預防動脈粥樣硬化可降低心肌梗塞的風險

P2Y12抑制劑單藥療法二級預防動脈粥樣硬化可降低心肌梗塞的風險

作者：

小柯機器人

發布時間：2020/5/11 15:58:20

義大利人文大學Giulio G Stefanini研究組比較了P2Y₁₂抑制劑和阿司匹林單藥治療二級預防動脈粥樣硬化的效果。相關論文於2020年5月9日發表在《柳葉刀》雜誌上。

抗血小板治療被推薦用於動脈粥樣硬化患者。

在這項系統回顧和薈萃分析中，研究組檢索PubMed、Embase等大型資料庫中2019年12月18日之前發表的研究論文，所有比較P2Y₁₂抑制劑和阿司匹林單藥治療對腦血管、冠狀動脈或外周動脈疾病患者二級預防作用的隨機試驗均被納入評估。共同主要終點是心肌梗塞和中風。關鍵次要終點是全因死亡和血管死亡。

該研究共納入9項隨機試驗，包括42108名參與者，其中21043名接受P2Y₁₂抑制劑治療，21065名接受阿司匹林治療。與接受阿司匹林治療的患者相比，接受P2Y₁₂抑制劑治療的患者發生心肌梗塞的危險性降低。但兩組間中風、全因死亡、血管死亡和大出血的風險均無顯著差異。無論使用哪種P2Y₁₂抑制劑，結果均一致。

總之，與阿司匹林單藥治療相比，P2Y₁₂抑制劑單藥治療可降低心肌梗塞的風險，且未增加中風、全因死亡或血管死亡的風險。

附：英文原文

Title: Monotherapy with a P2Y12 inhibitor or aspirin for secondary prevention in patients with established atherosclerosis: a systematic review and meta-analysis

Author: Mauro Chiarito, Jorge Sanz-Sánchez, Francesco Cannata, Davide Cao, Matteo Sturla, Cristina Panico, Cosmo Godino, Damiano Regazzoli, Bernhard Reimers, Raffaele De Caterina, Gianluigi Condorelli, Giuseppe Ferrante, Giulio G Stefanini

Issue&Volume: 2020/05/09

Abstract: Background

Antiplatelet therapy is recommended among patients with established atherosclerosis. We compared monotherapy with a P2Y 12 inhibitor versus aspirin for secondary prevention.

Methods

In this systematic review and meta-analysis, all randomised trials comparing P2Y 12 inhibitor with aspirin monotherapy for secondary prevention in patients with cerebrovascular, coronary, or peripheral artery disease were evaluated for inclusion. On Dec 18, 2019, we searched PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials. Additionally, we reviewed references from identified articles and searched abstracts from 2017 to 2019 presented at relevant scientific meetings. Data about year of publication, inclusion and exclusion criteria, sample size, baseline patients』 features including the baseline condition determining study inclusion (ie, cerebrovascular, coronary, or peripheral artery disease), P2Y 12 inhibitor type and dosage, aspirin dosage, endpoint definitions, effect estimates, follow-up duration, and percentage of patients lost to follow-up were collected. Odds ratios (ORs) and 95% CIs were used as metric of choice for treatment effects with random-effects models. Co-primary endpoints were myocardial infarction and stroke. Key secondary endpoints were all-cause death and vascular death. Heterogeneity was assessed with the I 2 index. This study is registered with PROSPERO (CRD42018115037).

Findings

A total of nine randomised trials were identified and included in this study, and 42108 patients randomly allocated to a P2Y 12 inhibitor (n=21043) or aspirin (n=21065) were included in our analyses. Patients who received a P2Y 12 inhibitor had a borderline reduction for the risk of myocardial infarction compared with those who received aspirin (OR 0·81 [95% CI 0·66–0·99]; I 2=10·9%). Risks of stroke (OR 0·93 [0·82–1·06]; I 2=34·5%), all-cause death (OR 0·98 [0·89–1·08]; I 2=0%), and vascular death (OR 0·97 [0·86–1·09]; I 2=0%) did not differ between patients who received a P2Y 12 inhibitor and those who received aspirin. Similarly, the risk of major bleeding (OR 0·90 [0·74–1·10]; I 2=3·9%) did not differ between patients who received a P2Y 12 inhibitor and those who received aspirin. The number needed to treat to prevent one myocardial infarction with P2Y 12 inhibitor monotherapy was 244 patients. Findings were consistent regardless of the type of P2Y 12 inhibitor used.

Interpretation

Compared with aspirin monotherapy, P2Y 12 inhibitor monotherapy is associated with a risk reduction for myocardial infarction and a comparable risk of stroke in the setting of secondary prevention. The benefit of P2Y 12 inhibitor monotherapy is of debatable clinical relevance, in view of the high number needed to treat to prevent a myocardial infarction and the absence of any effect on all-cause and vascular mortality.

DOI: 10.1016/S0140-6736(20)30315-9

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30315-9/fulltext