Meta-analysis Of Antiplatelet Drugs In ACS Patients With Renal Insufficiency

Objective: With the development of modern society,acute coronary syndrome has gradually become a major disease threatening human life and health in the world.Renal insufficiency has also become a recognized risk factor for acute coronary syndrome,which seriously affects the prognosis of this kind of patients.Antiplatelet drug therapy is the most important drug therapy for acute coronary syndrome.However,in patients with acute coronary syndrome with renal insufficiency,the coagulation mechanism is abnormal,that is,there is a risk of bleeding as well as the risk of ischemia.For acute coronary syndrome patients with renal insufficiency,the optimal antiplatelet therapy strategy remains unknown.The proposed by Meta analysis incorporating a number of research data,increase the efficiency of the original results of statistical and solve the inconsistency of the results of the study,and compare the cardiovascular events,bleeding events,myocardial infarction,stroke and all-cause death events of antiplatelet drugs in patients with acute coronary syndrome with renal insufficiency.It provides new reference evidence for the treatment strategy of antiplatelet drugs in this kind of patients.Methods: The data of PubMed,EMBASE,Cochrane,clinical trails,CNKI,VIP and Wanfang were searched by computer.the related literatures on the efficacy and safety of ticagrelor and clopidogrel in the treatment of acute coronary syndrome with renal insufficiency were collected,including randomized controlled trial(RCT)and cohort study(observational research and retrospective research).At the same time,relevant references,meeting abstracts and other materials were searched manually.After the corresponding quality evaluation of the included literatures,the relevant literatures meeting the requirements were extracted from the baseline data,and meta analysis was conducted with Stata11.0 software.Results: Five articles were included in the meta-analysis,including 2 RCT studies and 3 non RCT studies,totaling 18354 participants.Meta-analysis showed that the incidence of major adverse cardiac events(MACE)in ticagrelor group and clopidogrel group was statistically significant(RR=0.83,95%CI(0.73,0.94),I2=0.6%).The incidence of myocardial infarction(RR=0.76,95%CI(0.63,0.91),I2=0.0%),all-cause death(RR=0.84,95% CI(0.72,0.97),I2=29.6%)were significantly different.Theincidence of stroke(RR=1.00,95%CI(0.73,1.39),I2=0.0%)was not significantly different.The incidence of bleeding(RR=1.17,95% CI(1.00,1.38),I2=0.0%)was not significantly different.Conclusions: In patients with renal insufficiency with acute coronary syndrome treated with antiplatelet therapy,the incidence of major adverse cardiac events(MACE),myocardial infarction and all-cause death in ticagrelor group was lower than clopidogrel group,while the incidence of stroke was not significantly different from that in clopidogrel group,and the incidence of bleeding was not significantly different.