Laurent Bonello1,2, Marc Laine1, Gilles Lemesle3, Etienne Puymirat4, Thibaut Dabry1, Franck Thuny1, Franck Paganelli1, Daniel Aradi5, Corinne Frere6, Stéphane Burtey2,7, Dirk Sibbing8, Julien Mancini9. 1. Service de Cardiologie, Centre Hospitalier Universitaire de Marseille, Hôpital NORD, Aix-Marseille Université, Hôpital Nord, Marseille, France. 2. Vascular Research Center of Marseille, Aix-Marseille Université, Marseille, France. 3. Département de Cardiologie, Hôpital Universitaire de Lille, Lille, France. 4. Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France. 5. Heart Center Balatonfüred, Semmelweis University Budapest, Budapest, Hungary. 6. Department of Haematology, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France. 7. Centre de Néphrologie et Transplantation Rénale, Hopital de la Conception, Marseille, France. 8. Department of Cardiology, German Center for Cardiovascular Research, Ludwig-Maximilians-Universität, München, Germany. 9. Department of Public Health (BIOSTIC), Aix-Marseille University, Hôpital de la Timone, Marseille, France.
Abstract
BACKGROUND: The clinical benefit of anti-platelet agents in patients with chronic kidney disease (CKD) is uncertain. In addition, the risk-benefit ratio of potent oral P2Y12-adenosine diphosphate (ADP) receptor antagonists (PPAs), namely, prasugrel and ticagrelor, compared with clopidogrel in CKD patients suffering from acute coronary syndrome (ACS) remains unknown. OBJECTIVE: We performed a meta-analysis of all studies comparing the clinical outcomes of PPA and clopidogrel therapy in CKD patients suffering from ACS. METHODS: We searched PubMed, the Cochrane library, Google Scholar, Clinical trial.org and the abstracts of international cardiology congresses from April 2000 to October 2017. Clinical studies comparing PPA with clopidogrel in ACS patients with CKD were selected. Our literature research identified five studies which were included in the meta-analysis. The primary endpoint was a composite of major adverse cardiovascular events (MACEs) at the latest follow-up available. Secondary endpoint included bleedings. RESULTS: We included data from three sub-group analysis of randomized clinical trials and two prospective observational studies (n = 31,234). Overall, PPAs were associated with lower rates of major cardiovascular events, with a pooled hazard ratio (pHR) of 0.88 (95% confidence interval [CI]: 0.79-0.99; p = 0.03), without increased bleedings (pHR = 1.10) (95% CI: 0.95-1.27; p = 0.18). In a sensitivity analysis restricted to studies enrolling invasively managed patients, the benefit of PPA on MACE was maintained (pHR = 0.85) (95% CI: 0.77-0.93; p < 0.001), including a reduction in mortality (pHR = 0.82) (95% CI: 0.7-0.96; p = 0.016). CONCLUSION: Compared with clopidogrel, PPAs were associated with a reduced rate of MACE without increased bleedings in CKD patients with ACS. Among invasively managed patients, this benefit from PPA included a reduction in mortality. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: The clinical benefit of anti-platelet agents in patients with chronic kidney disease (CKD) is uncertain. In addition, the risk-benefit ratio of potent oral P2Y12-adenosine diphosphate (ADP) receptor antagonists (PPAs), namely, prasugrel and ticagrelor, compared with clopidogrel in CKDpatients suffering from acute coronary syndrome (ACS) remains unknown. OBJECTIVE: We performed a meta-analysis of all studies comparing the clinical outcomes of PPA and clopidogrel therapy in CKDpatients suffering from ACS. METHODS: We searched PubMed, the Cochrane library, Google Scholar, Clinical trial.org and the abstracts of international cardiology congresses from April 2000 to October 2017. Clinical studies comparing PPA with clopidogrel in ACS patients with CKD were selected. Our literature research identified five studies which were included in the meta-analysis. The primary endpoint was a composite of major adverse cardiovascular events (MACEs) at the latest follow-up available. Secondary endpoint included bleedings. RESULTS: We included data from three sub-group analysis of randomized clinical trials and two prospective observational studies (n = 31,234). Overall, PPAs were associated with lower rates of major cardiovascular events, with a pooled hazard ratio (pHR) of 0.88 (95% confidence interval [CI]: 0.79-0.99; p = 0.03), without increased bleedings (pHR = 1.10) (95% CI: 0.95-1.27; p = 0.18). In a sensitivity analysis restricted to studies enrolling invasively managed patients, the benefit of PPA on MACE was maintained (pHR = 0.85) (95% CI: 0.77-0.93; p < 0.001), including a reduction in mortality (pHR = 0.82) (95% CI: 0.7-0.96; p = 0.016). CONCLUSION: Compared with clopidogrel, PPAs were associated with a reduced rate of MACE without increased bleedings in CKDpatients with ACS. Among invasively managed patients, this benefit from PPA included a reduction in mortality. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Yong Huo; Frans Van de Werf; Yaling Han; Xavier Rossello; Stuart J Pocock; Chee Tang Chin; Stephen W-L Lee; Yi Li; Jie Jiang; Ana Maria Vega; Jesús Medina; Héctor Bueno Journal: Am J Cardiovasc Drugs Date: 2021-02-04 Impact factor: 3.571