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Comparative Efficac...
Comparative Efficacy and Safety of Oral P2Y12 Inhibitors in Acute Coronary Syndrome Network Meta-Analysis of 52 816 Patients From 12 Randomized Trials
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- Navarese, Eliano P. (author)
- Nicolaus Copernicus Univ, Antoni Jurasz Univ Hosp 1, Dept Cardiol & Internal Med, Bydgoszcz, Poland.;Univ Alberta, Fac Med, Edmonton, AB, Canada.;Systemat Invest & Res Intervent & Outcomes SIRIO, Bydgoszcz, Poland.
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- Khan, Safi U. (author)
- West Virginia Univ, Dept Internal Med, Morgantown, WV 26506 USA.
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- Kolodziejczak, Michalina (author)
- Nicolaus Copernicus Univ, Antoni Jurasz Univ Hosp 1, Dept Anaesthesiol & Intens Care, Bydgoszcz, Poland.;Systemat Invest & Res Intervent & Outcomes SIRIO, Bydgoszcz, Poland.
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- Kubica, Jacek (author)
- Nicolaus Copernicus Univ, Antoni Jurasz Univ Hosp 1, Dept Cardiol & Internal Med, Bydgoszcz, Poland.;Systemat Invest & Res Intervent & Outcomes SIRIO, Bydgoszcz, Poland.
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- Buccheri, Sergio (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Cannon, Christopher P. (author)
- Harvard Clin Res Inst, Boston, MA USA.
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- Gurbel, Paul A. (author)
- LifeBridgehealth, Sinai Hosp Baltimore, Sinai Ctr Thrombosis Res, Baltimore, MD USA.
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- De Servi, Stefano (author)
- IRCCS Multimed, Milan, Italy.
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- Budaj, Andrzej (author)
- Grochowski Hosp, Ctr Postgrad Med Educ, Warsaw, Poland.
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- Bartorelli, Antonio (author)
- Univ Milan, Ctr Cardiol Monzino, Milan, Italy.
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- Trabattoni, Daniela (author)
- Univ Milan, Ctr Cardiol Monzino, Milan, Italy.
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- Ohman, E. Magnus (author)
- Duke Univ, Med Ctr, Div Cardiol, Durham, NC 27710 USA.
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- Wallentin, Lars, 1943- (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Roe, Matthew T. (author)
- Duke Univ, Med Ctr, Div Cardiol, Durham, NC 27710 USA.
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- James, Stefan, 1964- (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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Nicolaus Copernicus Univ, Antoni Jurasz Univ Hosp 1, Dept Cardiol & Internal Med, Bydgoszcz, Poland;Univ Alberta, Fac Med, Edmonton, AB, Canada.;Systemat Invest & Res Intervent & Outcomes SIRIO, Bydgoszcz, Poland. West Virginia Univ, Dept Internal Med, Morgantown, WV 26506 USA. (creator_code:org_t)
- Ovid Technologies (Wolters Kluwer Health), 2020
- 2020
- English.
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In: Circulation. - : Ovid Technologies (Wolters Kluwer Health). - 0009-7322 .- 1524-4539. ; 142:2, s. 150-160
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Background: New randomized, controlled trials have become available on oral P2Y(12)inhibitors in acute coronary syndrome. We aimed to evaluate current evidence comparing the efficacy and safety profile of prasugrel, ticagrelor, and clopidogrel in acute coronary syndrome by a meta-analysis of randomized controlled trials.Methods: We performed a network meta-analysis and direct pairwise comparison analysis of efficacy and safety outcomes from 12 randomized controlled trials including a total of 52 816 patients with acute coronary syndrome.Results: In comparison with clopidogrel, ticagrelor significantly reduced cardiovascular mortality (hazard ratio [HR], 0.82 [95% CI, 0.72-0.92]) and all-cause mortality (HR, 0.83 [95% CI, 0.75-0.92]), whereas there was no statistically significant mortality reduction with prasugrel (HR, 0.90 [95% CI, 0.80-1.01] and HR, 0.92 [95% CI, 0.84-1.02], respectively). In comparison with each other, there were no significant differences in mortality (HR prasugrel versus ticagrelor, 1.10 [95% CI, 0.94-1.29] and 1.12 [95% CI, 0.98-1.28]). In comparison with clopidogrel, prasugrel reduced myocardial infarction (HR, 0.81 [95% CI, 0.67-0.98]), whereas ticagrelor showed no risk reduction (HR, 0.97 [95% CI, 0.78-1.22]). Differences between prasugrel and ticagrelor were not statistically significant. Stent thrombosis risk was significantly reduced by both ticagrelor and prasugrel versus clopidogrel (28%-50% range of reduction). In comparison with clopidogrel, both prasugrel (HR, 1.26 [95% CI, 1.01-1.56]) and ticagrelor (HR, 1.27 [95% CI, 1.04-1.55]) significantly increased major bleeding. There were no significant differences between prasugrel and ticagrelor for all outcomes explored.Conclusions: Prasugrel and ticagrelor reduced ischemic events and increased bleeding in comparison with clopidogrel. A significant mortality reduction was observed with ticagrelor only. There was no efficacy and safety difference between prasugrel and ticagrelor.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- acute coronary syndrome
- meta-analysis
- P2Y(12)protein
- human
Publication and Content Type
- ref (subject category)
- art (subject category)
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Navarese, Eliano ...
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Khan, Safi U.
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Kolodziejczak, M ...
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Kubica, Jacek
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Buccheri, Sergio
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Cannon, Christop ...
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Gurbel, Paul A.
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De Servi, Stefan ...
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Budaj, Andrzej
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Bartorelli, Anto ...
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Trabattoni, Dani ...
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Ohman, E. Magnus
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Wallentin, Lars, ...
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Roe, Matthew T.
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James, Stefan, 1 ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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Circulation
- By the university
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Uppsala University