A Meta-Analysis Of Platelet Reactivity With MACE In ACS Patients Post-PCI Under Dual Antiplatelet Therapy

Background: Acute Coronary Syndrome(ACS)is a type of acute ischemic heart disease and the main cause of death from cardiovascular diseases.The Chinese "Acute Coronary Syndrome Emergency Rapid Diagnosis and Treatment Guideline(2019)" recommends that ACS patients undergo Percutaneous Coronary Intervention(PCI)as soon as possible.Many guidelines suggest that long-term Dual Antiplatelet Therapy(DAPT),such as aspirin combined with P2Y12 receptor antagonists,can effectively reduce the incidence of Major Adverse Cardiovascular Events(MACE),but adverse cardiovascular events may still occur during treatment.Numerous clinical studies have explored the correlation between Platelet Reactivity(PR)under DAPT and MACE,but the results are inconsistent.Therefore,the necessity of platelet function testing and how to guide antiplatelet therapy based on test results for post-PCI ACS patients remain controversial,requiring further research to confirm their effectiveness and determine the best clinical practice.Objective: By using a meta-analysis approach,this study aims to investigate the correlation between platelet reactivity and adverse events in ACS patients receiving dual antiplatelet therapy after percutaneous coronary intervention.Methods: Clinical studies on the correlation between platelet reactivity and adverse cardiovascular events in post-PCI ACS patients under dual antiplatelet therapy were collected from Pub Med,EMBASE,and Cochrane Library databases up to October 31,2022.Selected articles meeting the set inclusion and exclusion criteria were independently analyzed by two researchers,who extracted data and assessed the risk of bias in the included studies.Review Manager 5.3 software was used to calculate the meta-analysis effect size and heterogeneity test,while Stata 15.0software was employed to explore sources of heterogeneity and assess publication bias.Results: A total of 12 studies on the correlation between platelet reactivity and adverse cardiovascular events in post-PCI ACS patients under dual antiplatelet therapy were included.The meta-analysis results showed that,for ACS patients receiving PCI,those with high platelet activity had a higher risk of major adverse cardiovascular events(RR=1.79,P<0.001)compared to those with non-high platelet activity over 1-2 years of DAPT treatment.High platelet reactivity was independently associated with all-cause mortality(RR=2.26,P<0.001),cardiac death(RR=1.98,P<0.001),myocardial infarction(RR=2.87,P<0.001),in-stent restenosis(RR=1.87,P=0.004),and stroke(RR=1.62,P=0.04),but not with coronary revascularization events(RR=0.99,P=0.96).Meta-regression results revealed that region(P=0.99),ACS patient type(P=0.16),drug regimen(P=0.48),testing method(P=0.51),sampling time(P=0.70),follow-up time(P=0.45),and PCI strategy(P=0.27)were not sources of heterogeneity,while the definition of MACE events might be a source of heterogeneity.Conclusion: This meta-analysis indicates that high platelet activity in ACS patients receiving PCI and undergoing 1-2 years of DAPT treatment is independently and positively correlated with major adverse cardiovascular events,all-cause mortality(or cardiac death),recurrent myocardial infarction,in-stent restenosis,and stroke events.These associations are not influenced by factors such as region,ACS patient type,drug loading dose,testing method,sampling time,follow-up duration,or PCI strategy.This suggesting that platelet reactivity testing has clinical translational significance in predicting patients’ risk of adverse cardiovascular events.