TITLE

2010 - Review: Third-generation P2Y12 inhibitors reduce mortality after PCI more than clopidogrel

AUTHOR(S)
Hillegass, William B.
PUB. DATE
March 2011
SOURCE
ACP Journal Club;3/20/2011, Vol. 154 Issue 3, p5
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Question Do third-generation P2Y[sub 12] inhibitors reduce mortality more than clopidogrel after percutaneous coronary intervention (PCI)? Review scope Included studies compared third-generation P2Y[sub 12] inhibitors with clopidogrel (or with placebo before clopidogrel in the case of short half-life P2Y[sub 12] inhibitors) in populations in which é>70% of coronary patients had PCI and outcomes included mortality and bleeding. Other outcomes included major adverse cardiac events (MACE) and stent thrombosis. Review methods MEDLINE and Cochrane Controlled Trials Register were searched from 1980 to January 2010 for full-text articles, substudies, and meeting abstracts; reference lists of relevant studies, reviews, editorials, and letters were reviewed. 8 randomized controlled trials (RCTs) (n =>48>599) met the selection criteria; 94% of patients had acute coronary syndromes (ACSs), and 84% had PCI. P2Y[sub 12] inhibitors were prasugrel (3 RCTs), cangrelor (2 RCTs), ticagrelor (2 RCTs), and elinogrel (1 RCT). Clopidogrel loading dose ranged from 300 to 600 mg. Main results All PCI patients: Patients allocated to third-generation P2Y[sub 12] inhibitors had lower risk for mortality, MACE, and stent thrombosis and higher risk for major bleeding than those allocated to clopidogrel (Table). Groups did not differ for stroke (0.72% vs 0.38%, P =>0.62). ST-segment elevation myocardial infarction (STEMI) patients having PCI: Patients allocated to third-generation P2Y[sub 12] inhibitors had lower risk for mortality, MACE, and stent thrombosis than those allocated to clopidogrel (Table) but higher risk for stroke (1.54% vs 1.13%, P =>0.02). Groups did not differ for major bleeding (Table). Conclusion Third-generation P2Y[sub 12] inhibitors reduce risk for mortality and increase risk for major bleeding after PCI; a similar reduction in mortality was seen in patients with STEMI, without an increased risk for major bleeding.
ACCESSION #
78325710

 

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