A Meta-analysis Of The Efficacy And Safety Of Ticagrelor In Improving Coronary Microvascular Applications After PCI In Patients With Coronary Heart Disease

Objective: To explore the effectiveness and safety of ticagrelor in coronary artery disease,and to provide a basis for more reasonable antiplatelet therapy.Methods: Domestic and foreign databases,including China Knowledge Network(CNKI),Wanfang,VIP(VIP),CBM,Cochrane,Pub Med,Embase,screened RCT for PCI in ticagrelor group and clopidogrel group,respectively,one group gave ticagrelor combined with aspirin,and the other group received clopidogrel combined with aspirin.Meta-analysis was performed using Rev Man5.3 software to observe the relevant indicators of efficacy and safety of coronary microvascular therapy,IMR,CFR;PT,FIB,MPAR;MACE incidence and incidence of adverse reactions.Heterogeneity analysis was evaluated using I2,using the RR and its 95%CI to represent the pooled statistics for categorical variables.MD and 95%CI.Fixed or random effects models were used for the analysis.And to assess the possibility of publication bias and to assess stable study findings using sensitivity analysis.Results: A total of 11 RCTs meeting the inclusion criteria were included in this study.All 10 studies reported the results of immediate IMR after PCI,and the analysis showed that ticagrelor significantly reduced postoperative IMR over clopidogrel(MD=-3.92,95% CI:-4.55 to-3.31,Z=12.56,P <0.00001).Three studies reported the results of IMR 5 to 6 months after PCI,and the analysis showed that ticagrelor significantly reduced IMR 5 to 6 months after clopidogrel(MD=-5.10,95% CI:-6.49 to-3.71,Z=7.19,P <0.00001).Nine studies reported the results of CFR after PCI,and the analysis showed that ticagrelor improved postoperative CFR compared with clopidogrel(MD=0.45,95%CI: 0.33 to 0.57,Z=7.30,P <0.00001).Five studies reported the results of PT after PCI,and the analysis showed that ticagrelor reduced postoperative PT over clopidogrel(MD=-2.44,95% CI:-3.30 to-1.58,Z=5.58,P <0.00001).Three studies reported the results of FIB after PCI,and the analysis showed that ticagrelor reduced postoperative FIB over clopidogrel(MD=-0.57,95% CI:-0.81to-0.33,Z=4.63,P <0.00001).Three studies reported the results of MPAR after PCI,and the analysis showed that ticagrelor was more effective after surgery(MD=-13.34,95% CI:-15.86to-10.81,Z=10.35,P <0.00001).Three studies reported the incidence of MACE after PCI,and the analysis showed that ticagrelor was more effective in reducing the incidence of postoperative MACE(RR=0.34,95%CI(0.19,0.62),Z=3.55,P=0.0004).Four studies reported the results of the incidence of adverse reactions after PCI,and the analysis showed that ticagrelor reduced the incidence of postoperative adverse effects compared with clopidogrel(RR=0.45,95%CI(0.26,0.77),Z=2.93,P=0.003).The results of the sensitivity analysis were robust,and the inverted funnel plot suggested a low possibility of publication bias.Conclusion: After PCI of coronary heart disease,ticagrelor is superior to clopidogrel in antiplatelet therapy,which can improve coronary microvessels to a greater extent.Compared with clopidogrel,the incidence of adverse reactions and MACE is lower.