Meta-analysis Of Efficacy And Safety Of Novel P2Y12 Receptor Inhibitors Compared With Clopidogrel In East Asian Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Objectives: This meta-analysis was designed to evaluate the efficacy and safety of two novel P2Y12 receptor inhibitors(prasugrel and ticagrelor)compared with clopidogrel in east Asian patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods: Pub Med,Embase,Web of Science and Cochrane Central Register of Controlled Trials(CENTRAL)were searched for articles published up to March,2020.Two reviewers independently screened literatures,extracted data and assessed the methodological quality of the included studies according to the inclusion and exclusion criteria.Then Meta-analysis was performed using Rev Man 5.3 software.Results: 18 studies with a total of 5490 East Asian patients were included in this meta-analysis.In East Asian ACS patients,the novel P2Y12 receptor inhibitor group was associated with a lower incidence of myocardial infarction(MI)(4.23% vs6.37%,OR = 0.66,95%CI(0.51,0.85),P = 0.001),stent thrombosis(ST)(0.25% vs1.30%,OR = 0.26,95%CI(0.10,0.63),P = 0.003),and major adverse cardiovascular events(MACE)(6.89% vs 12.23%,OR = 0.46,95%CI(0.32,0.66),P< 0.0001)compared with clopidogrel group.All-cause death,cardiac death,repeat revascularization,stroke,and major bleeding events presented similar risks for the two groups.In the ticagrelor subgroup,ticagrelor resulted in a lower incidence of MI(3.00% vs 4.74%,OR = 0.65,95% CI(0.45,0.96),P = 0.03),ST(0.18% vs 2.66%,OR = 0.15,95% CI(0.04,0.56),P = 0.005),and MACE(6.24% vs 15.12%,OR =0.35,95% CI(0.25,0.49),P < 0.00001),but not with a higher incidence of major bleeding events(3.64% vs 2.75%,OR=1.36,95%CI(0.87,2.13),P=0.18)compared with clopidogrel.In the prasugrel subgroup,prasugrel resulted in a lower incidence of MI(5.86% vs 8.55%,OR=0.66,95%CI(0.48,0.92),P=0.01)and MACE(7.42%vs 9.85%,OR=0.73,95%CI(0.54,0.98),P=0.04)compared with clopidogrel.Conclusions: In East Asian ACS patients undergoing PCI,the novel P2Y12 receptor inhibitors(prasugrel and ticagrelor)might be a better alternative to clopidogrel,in combination with aspirin for antiplatelet therapy.