Newer P2Y12 Inhibitors vs Clopidogrel in Acute Myocardial Infarction With Cardiac Arrest or Cardiogenic Shock: A Systematic Review and Meta-analysis期刊界 All Journals 搜尽天下杂志传播学术成果专业期刊搜索期刊信息化学术搜索

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Newer P2Y12 Inhibitors vs Clopidogrel in Acute Myocardial Infarction With Cardiac Arrest or Cardiogenic Shock: A Systematic Review and Meta-analysis

Institution:	1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN;2. Division of General Internal Medicine, Mayo Clinic, Rochester, MN;3. Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN;4. Department of Medicine, Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN;5. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN;6. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;7. Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN;8. Department of Medicine, Staten Island University Hospital, Staten Island, NY;9. Department of Medicine, Rosalind Franklin University Hospital, Chicago, IL;10. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA;11. Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta;12. Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC;1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA;2. Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA;3. Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Labotorary, Mayo Clinic, Rochester, MN, USA;1. Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH;2. Division of Medicine, Forrest General Hospital, Hattiesburg, MS;3. Department of Cardiology, Reading Hospital–Tower Health System, West Reading, PA;4. Section of Cardiology, Baylor College of Medicine, Houston, TX;1. Pharmacy Supply Solutions, Mayo Clinic, Rochester, MN;2. Pharmacy Services, Mayo Clinic, Rochester, MN;1. Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL;2. Department of Diagnostic Radiology, Mayo Clinic, Jacksonville, FL;3. Division of Nephrology, Mayo Clinic, Jacksonville, Florida, United States of America;4. Department of Transplantation, Mayo Clinic, Jacksonville, Florida, United States of America

Abstract:	ObjectiveTo evaluate the outcomes, safety, and efficacy of dual antiplatelet therapy (DAPT) with newer P2Y₁₂ inhibitors compared with clopidogrel in patients with acute myocardial infarction (AMI) complicated by cardiac arrest (CA) or cardiogenic shock (CS).Patients and MethodsMEDLINE, EMBASE, and the Cochrane Library were queried systematically from inception to January 2021 for comparative studies of adults (≥18 years) with AMI-CA/CS receiving DAPT with newer P2Y₁₂ inhibitors as opposed to clopidogrel. We compared outcomes (30-day or in-hospital and 1-year all-cause mortality, major bleeding, and definite stent thrombosis) of newer P2Y₁₂ inhibitors and clopidogrel in patients with AMI-CA/CS.ResultsEight studies (1 randomized trial and 7 cohort studies) comprising 1100 patients (695 63.2%] receiving clopidogrel and 405 36.8%] receiving ticagrelor or prasugrel) were included. The population was mostly male (68.5%-86.7%). Risk of bias was low for these studies, with between-study heterogeneity and subgroup differences not statistically significant. Compared with the clopidogrel cohort, the newer P2Y₁₂ cohort had lower rates of early mortality (odds ratio OR], 0.60; 95% CI, 0.45 to 0.81; P=.001) (7 studies) and 1-year mortality (OR, 0.51; 95% CI, 0.36 to 0.71; P<.001) (3 studies). We did not find a significant difference in major bleeding (OR, 1.21; 95% CI, 0.71 to 2.06; P=.48) (6 studies) or definite stent thrombosis (OR, 2.01; 95% CI, 0.63 to 6.45; P=.24) (7 studies).ConclusionIn patients with AMI-CA/CS receiving DAPT, compared with clopidogrel, newer P2Y₁₂ inhibitors were associated with lower rates of early and 1-year mortality. Data on major bleeding and stent thrombosis were inconclusive.

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