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Guided versus standard antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

The Lancet (British edition), 2021-04, Vol.397 (10283), p.1470-1483 [Peer Reviewed Journal]

2021 Elsevier Ltd ;Copyright © 2021 Elsevier Ltd. All rights reserved. ;COPYRIGHT 2021 Elsevier B.V. ;2021. Elsevier Ltd ;ISSN: 0140-6736 ;EISSN: 1474-547X ;DOI: 10.1016/S0140-6736(21)00533-X ;PMID: 33865495

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  • Title:
    Guided versus standard antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis
  • Author: Galli, Mattia ; Benenati, Stefano ; Capodanno, Davide ; Franchi, Francesco ; Rollini, Fabiana ; D'Amario, Domenico ; Porto, Italo ; Angiolillo, Dominick J
  • Subjects: Acute coronary syndromes ; Analysis ; Angioplasty ; Bias ; Bleeding ; Blood platelets ; Cardiac patients ; Cardiology ; Care and treatment ; Cerebral infarction ; Clinical trials ; Collaboration ; Death ; Design ; Estimates ; Genetic screening ; Heart attacks ; Heterogeneity ; Implants ; Intervention ; Investigations ; Medical research ; Medicine, Experimental ; Meta-analysis ; Model testing ; Mortality ; Myocardial infarction ; Pharmacodynamics ; Platelets ; Reduction ; Risk assessment ; Safety ; Sensitivity analysis ; Statistical analysis ; Stents ; Stroke ; Systematic review ; Therapy ; Thromboembolism ; Thrombosis ; Tradeoffs ; Transluminal angioplasty
  • Is Part Of: The Lancet (British edition), 2021-04, Vol.397 (10283), p.1470-1483
  • Description: Whether guided selection of antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) is effective in improving outcomes compared with standard antiplatelet therapy remains controversial. We assessed the safety and efficacy of guided versus standard selection of antiplatelet therapy in patients undergoing PCI. For this systematic review and meta-analysis, from Aug 20 to Oct 25, 2020, we searched MEDLINE (via PubMed), Cochrane, Embase, and Web of Science databases for randomised controlled trials and observational studies published in any language that compared guided antiplatelet therapy, by means of platelet function testing or genetic testing, versus standard antiplatelet therapy in patients undergoing PCI. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. Risk ratios (RRs) and 95% CIs were used with random-effects or fixed-effect models according to the estimated heterogeneity among studies assessed by the I2 index. Coprimary endpoints were trial-defined primary major adverse cardiovascular events and any bleeding. Key secondary endpoints were all-cause death, cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis, and major and minor bleeding. This study is registered with PROSPERO (CRD42021215901). 3656 potentially relevant articles were screened. Our analysis included 11 randomised controlled trials and three observational studies with data for 20 743 patients. Compared with standard therapy, guided selection of antiplatelet therapy was associated with a reduction in major adverse cardiovascular events (RR 0·78, 95% CI 0·63–0·95, p=0·015) and reduced bleeding, although not statistically significant (RR 0·88, 0·77–1·01, p=0·069). Cardiovascular death (RR 0·77, 95% CI 0·59–1·00, p=0·049), myocardial infarction (RR 0·76, 0·60–0·96, p=0·021), stent thrombosis (RR 0·64, 0·46–0·89, p=0·011), stroke (RR 0·66, 0·48–0·91, p=0·010), and minor bleeding (RR 0·78, 0·67–0·92, p=0·0030) were reduced with guided therapy compared with standard therapy. Risks of all-cause death and major bleeding did not differ between guided and standard approaches. Outcomes varied according to the strategy used, with an escalation approach associated with a significant reduction in ischaemic events without any trade-off in safety, and a de-escalation approach associated with a significant reduction in bleeding, without any trade-off in efficacy. Guided selection of antiplatelet therapy improved both composite and individual efficacy outcomes with a favourable safety profile, driven by a reduction in minor bleeding, supporting the use of platelet function or genetic testing to optimise the choice of agent in patients undergoing PCI. None.
  • Publisher: England: Elsevier Ltd
  • Language: English
  • Identifier: ISSN: 0140-6736
    EISSN: 1474-547X
    DOI: 10.1016/S0140-6736(21)00533-X
    PMID: 33865495
  • Source: ProQuest One Psychology
    ProQuest Central
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