普拉格雷与替格瑞洛治疗急性冠脉综合征有效性和安全性比较的Meta分析

Efficacy and Safety of Prasugrel Versus Ticagrelor in the Treatment of Acute Coronary Syndrome:a Meta-analysis

目的:系统评价普拉格雷与替格瑞洛治疗急性冠脉综合征(ACS)的有效性与安全性。方法:计算机检索PubMed、Embase、the Cochrane Library、CNKI、WanFang Data和VIP数据库,搜集比较普拉格雷与替格瑞洛治疗ACS的随机对照试验(RCT),检索时限均为从建库至2020年2月28日,由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入8个RCT,包括5826例患者。Meta分析结果显示,普拉格雷组在降低主要不良心血管事件(MACE)发生率[RR=0.78,95%CI(0.64,0.96),P=0.02]及心肌梗死(MI)发生率[RR=0.68,95%CI(0.51,0.92),P=0.01]方面优于替格瑞洛组,差异有统计学意义;在其他不良心血管结局和出血事件发生率方面,两组差异无统计学意义(P>0.05)。结论:当前证据显示,与替格瑞洛相比,在ACS患者中使用普拉格雷可以降低MACE及MI发生率,且不增加其他不良心血管结局和出血事件发生风险。

Objective:To systematically review the efficacy and safety of prasugrel versus ticagrelor in the treatment of acute coronary syndrome(ACS).Methods:Databases including PubMed,Embase,the Cochrane Library,CNKI,WanFang Data and VIP database were searched to collect randomized controlled trials(RCTs)evaluating efficacy and safety of prasugrel versus ticagrelor for treatment of ACS from inception to February 28,2020.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies using Cochrane risk bias assessing tool.Meta-analysis was performed using RevMan 5.3 software.Results:Totally,8 studies including 5826 patients were included in this study.The results of Meta-analysis showed that the risk of major adverse cardiovascular events(RR=0.78,95%CI 0.64 to 0.96,P=0.02)and myocardial infarction(RR=0.68,95%CI 0.51 to 0.92,P=0.01)in prasugrel group was lower than that in ticagrelor group,while there was no significant difference in other adverse cardiovascular outcomes and bleeding risk(P>0.05).Conclusion:Current evidence suggests that compared with ticagrelor,prasugrel can reduce the risk of major adverse cardiovascular events and myocardial infarction in patients with ACS,without increasing the risk of other adverse cardiovascular outcomes and bleeding events.