| Object:To comprehensively assess the efficacy,safety,and cost-effectiveness of two antiplatelet drugs after percutaneous coronary intervention in hospitalized myocardial infarction patients,and to provide a basis for clinical selection of treatment strategies for myocardial infarction patients.Methods:1.Literature on RCTs and cohort studies of clopidogrel(experimental)and tigretol(control)were collected by computerized searches in Pub Med,Cochrane Library,CNKI,Wanfang database,and Vipshop database.The quality of the included articles was assessed using the Downs and Blacks tool,and Rev Man 5.3 and Stata 11.0 were used for metastasis analysis.2.The case data of cardiovascular medicine patients in a hospital from December 2020 to August 2021 were extracted,and patients who met the above criteria of(1)clearly diagnosed myocardial infarction(2)aged between 45 and 75 years(3)patients receiving PCI(percutaneous coronary intervention)for the first time(4)complete data of review index(5)taking tigretol or clopidogrel after surgery were included in the study.Data were processed using SPSS Statistics 22.0software,and all data were first tested for normality.Left heart ejection fraction(LVEF)was compared with t-test for significant differences before and after treatment,and platelet count(PLT)and troponin T were compared with F-Wilcoxon for statistically significant differences before and after treatment.3.Binary logistic regression was used to analyze whether age,gender,days of hospitalization,medical insurance or not,previous diabetes,hypertension,dyslipidemia,review interval and total cost had an effect on medication choice.Results:1.A total of 21 studies were included in the meta-analysis,and the results showed that in terms of efficacy,postoperative TIMI grade III [OR=0.31,95% CI(0.23-0.42),p<0.00001] was significantly lower in the experimental group compared with the control group;in terms of safety,postoperative bleeding in the experimental group [OR=0.67,95% CI(0.59-0.76),p<0.00001],the incidence of postoperative bleeding in the experimental group was significantly lower than that in the control group,and the incidence of major adverse cardiovascular events [OR=1.22,95% CI(1.10～1.35),p=0.0001],the incidence of major adverse cardiovascular events in both groups was statistically significantly lower in the tigretol group,death[OR=0.93,95% CI(0.80-1.08),p=0.35] was not significantly different,Other events(gastrointestinal reactions,dyspnea,rash,vomiting,hyperuricemia)[RR=0.65,95% CI(0.49 to 0.87),p=0.004] were significantly different,with a high incidence of adverse events for tigretol.2.132 cases were extracted,and there was no significant difference between patients’ LVEF and PLT before and after treatment,and there was a significant difference between troponin T before and after treatment(p < 0.001).The improvement rate of patients’ troponin T index was used as the effect value.There were 54 cases in the clopidogrel treatment group with 47 treatment improvements(87% treatment improvement rate rate)and 78 cases in the tigretol group with 69 treatment improvements(88% treatment improvement rate).Cost-effectiveness analysis showed a cost-effectiveness ratio of 32970.33 in the clopidogrel group and 37196.77 in the tigretol group.3.Binary logistic regression analysis showed that age,history of hypertension,and the presence of ST elevation on ECG were significantly associated with drug selection for treatment.Conclusion:1.Clopidogrel is relatively less effective than tigretol in treating patients with myocardial infarction,but has a relatively good safety profile.2.A study found that clopidogrel is a more cost-effective treatment after percutaneous coronary intervention for acute myocardial infarction. |
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