Meta-analysis Of Efficacy And Safety Of Pretreatment With P2Y12 Receptor Antagonists In Patients With NSTE-ACS Before Interventional Therapy

Objective:To systematically evaluate the efficacy and safety of pretreatment with clopidogrel,ticagrelor and prasugrel in patients with NSTE-ACS before interventional therapy,so as to provide evidence-based basis and reference for rational use of P2Y12 receptor antagonists in patients with NSTE-ACS before interventional therapy.Methods:PubMed,Embase,Web of science,ESCO,Cochrane Central Register of Controlled Trials,CNKI,VIP,Wanfang Database and SinoMed(CBM)were searched by computer.Through rigorous literature screening,randomized controlled trial(RCT)literatures of NSTE-ACS patients pretreated with P2Y12 receptor antagonists before intervention were included,the full text was downloaded,the literature quality was strictly evaluated,and the data were extracted,and meta-analysis was performed using Stata 11.0 and addis-1.16.6 software.Results:A total of 14 RCTs were included.Meta-analysis showed that the incidence of MACE events was different between ticagrelor and clopidogrel(OR = 0.51,95% CI: 0.385-0.647,P < 0.05).There was no significant difference between prasugrel and clopidogrel(OR = 1.058,95% CI: 0.979-1.142,P > 0.05).There was a difference between ticagrelor and prasugrel(OR = 0.43,P > 0.05).95% CI: 0.28-0.66,P < 0.05);the incidence of bleeding events was different between ticagrelor and clopidogrel(OR = 1.548,95% CI: 1.004-2.385,P < 0.05);there was a difference between prasugrel and clopidogrel(OR = 1.898,95% CI: 1.557-2.315,P < 0.05);there was no significant difference between ticagrelor and prasugrel(OR = 0.82,95% CI: 0.30-2.09,P > 0.05).There was a difference in the incidence of adverse events(OR=3.766,95% CI: 2.145-6.612,P<0.05)except bleeding between ticagrelor and clopidogrel,with no significant difference in the incidence of myocardial infarction events(OR=0.517,95% CI: 0.279-0.959,P>0.05).Conclusions:Ticagrelor is superior to clopidogrel in the incidence of dyspnea and hemorrhage,but superior to clopidogrel in the incidence of MACE and similar to clopidogrel in the incidence of myocardial infarction events in the pre-PCI anticoagulation treatment of NSTE-ACS patients;prasugrel is similar to clopidogrel in the incidence of MACE and higher than clopidogrel in the incidence of hemorrhage;Ticagrelor is superior to clopidogrel in the incidence of MACE.It was superior to prasugrel,but the incidence of bleeding events was not significantly different between the two drugs.