A Meta-analysis Of The Effect And Safety Of Ticagrelor And Clopidogrel In Patients With Acute Coronary Syndrome And Diabetes Mellitus At Different Follow-up Times

Objective: Meta-analysis was used to evaluate the efficacy and safety of ticagrelor and clopidogrel in patients with acute coronary syndrome(ACS)complicated with diabetes mellitus(DM)during different follow-up periods.Methods: Pub Med,EMbase,cnki and vip databases were searched by calculator to gather the randomized controlled trials(RCTs)of ticagrelor and clopidogrel used to cure patients with acute coronary syndrome combined with diabetes.The retrieval time limit is from the beginning to April 30 th 2020.Screening literature,extracting data and then evaluating literature quality.Using Revman 5.1 and stata 15 software for meta-analysis to the studies which meet the requirements.Results: This study including 23 literatures,with a total of 13843 cases.Efficacy:Compared with the clopidogrel group,the ticagrelor group has a lower incidence of major adverse cardiovascular events(MACE)and a higher left ventricular ejection fraction(LVEF).The results have no connection with the follow-up time(P < 0.05).When the follow-up time was short(< 6m),there was no significant difference in all-cause mortality between these two groups,and the left ventricular end diastolic dimension(LVEDD)of the ticagrelor group was higher when compared with the clopidogrel group(MD=3.13,95%CI=1.38～4.88,P=0.0004).When the follow-up time was longer(≥6m),compared with clopidogrel group,the ticagrelor group had lower all-cause mortality(RR=0.76,95%CI=0.63～0.92,P=0.004)and LVEDD(MD=-4.19,95%CI=-5.36～-3.02,P<0.0001).Safety: Compared with the clopidogrel group,the ticagrelor group has a higher incidence of dyspnea and no statistical difference in the incidence of bleeding events,which was independent of the length of follow-up.But when the follow-up time is over 12 m,there may be a difference between the observation group and the control group in the incidence of bleeding events(P=0.06).Conclusion: For patients with acute coronary syndrome complicated with diabetes,the efficacy of ticagrelor was better than clopidogrel,and the safety was lower than clopidogrel when the follow-up time was long(≥6m).