Efficacy And Safety Of Triple Antiplatelet Treatment In Patients Undergoing Coronary Stent Implantation: A Systematic Review And Meta-analysis

OBJECTIVE: Systematic evaluation of the efficacy and safety of triple antiplatelet(TAT: aspirin,clopidogrel,cilostazol)in the treatment of patients with coronary heart disease after percutaneous coronary intervention(PCI).METHODS: Systematic literature search was done from the databases of PubMed,Web of science,The Cochrace Libtary,EMbase,CNKI,VIP,Wanfang,CBM.Randomized controlled trials(RCTs)comparing the effectiveness and safety between triple therapy and dual therapy in patients after coronary stents placement were included.Endpoints included Major adverse cardiac cerebrovascular events(MACCE),target lesion revascularization(TLR),target vessel revascularization(TVR),death,stent thrombosis,bleeding and adverse drug reactions during a 6–12 months period.Statistical analysis was performed using Revman 5.3 software,and data biasing and sensitivity analysis were performed using Stata15.0.RESULTS: A total of 25 RCTs were included in this Meta-analysis,including 7847 patients,including 3920 in the TAT group and 3927 in the DAT group.The results of the Meta-analysis compared with DAT showed:(1)TAT in major adverse cardiac cerebrovascular events [RR=0.59,95% CI(0.47,0.74),P <0.00001],cardiac death [RR=0.57,95% CI(0.38,0.86),P = 0.008],nonfatal myocardial infarction [RR = 0.64,95% CI(0.45,0.92),P = 0.01],stent thrombosis [RR = 0.55,95% CI(0.34,0.89),P = 0.01],in-stent restenosis [RR=0.61,95% CI(0.50,0.74),P <0.00001],target lesion reconstruction [RR=0.55,95% CI(0.42,0.71),P <0.00001],target vessel reconstruction [RR= 0.63,95 The incidence of %CI(0.53,0.75),P < 0.00001] was significantly less than that of the DAT group.(2)There was no significant difference in the incidence of stroke between the two groups [RR = 0.63,95% CI(0.38,1.05),P = 0.08].(3)There were no significant differences in the safety rating between severe bleeding,palpitations,liver damage,leukopenia,and thrombocytopenia.The DAT group was less likely to have mild bleeding,gastrointestinal reactions,rashes,and headaches.In the TAT group,this difference was statistically significant.(4)subgroup analysis showed that when the lesion length was >25mm,TAT significantly reduced the incidence of cardiovascular and cerebrovascular events,target lesions/vascular reconstruction and in-stent restenosis compared with DAT.Conclusion: Patients with coronary heart disease undergoing TAT after PCI can reduce the incidence of adverse events and in-stent restenosis compared with DAT,but will not increase the incidence of severe bleeding and serious drug-related adverse reactions,and have good efficacy and safety.