Guided versus standard antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis
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 antiplatel...
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| Veröffentlicht in: | The Lancet (British edition) 2021-04, Vol.397 (10283), p.1470-1483 |
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| creator | Galli, Mattia Benenati, Stefano Capodanno, Davide Franchi, Francesco Rollini, Fabiana D'Amario, Domenico Porto, Italo Angiolillo, Dominick J |
| 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 ant |
| doi_str_mv | 10.1016/S0140-6736(21)00533-X |
| format | Article |
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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.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(21)00533-X</identifier><identifier>PMID: 33865495</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Acute coronary syndromes ; Angioplasty ; Antiplatelet therapy ; Bias ; Bleeding ; Blood platelets ; Cardiology ; Cerebral infarction ; Clinical trials ; Collaboration ; Death ; Design ; Estimates ; Genetic screening ; Heart attacks ; Heterogeneity ; Implants ; Intervention ; Investigations ; Meta-analysis ; Model testing ; Mortality ; Myocardial infarction ; Observational studies ; Pharmacodynamics ; Platelets ; Reduction ; Risk assessment ; Safety ; Sensitivity analysis ; Statistical analysis ; Stents ; Stroke ; Systematic review ; Therapy ; Thromboembolism ; Thrombosis ; Tradeoffs</subject><ispartof>The Lancet (British edition), 2021-04, Vol.397 (10283), p.1470-1483</ispartof><rights>2021 Elsevier Ltd</rights><rights>Copyright © 2021 Elsevier Ltd. All rights reserved.</rights><rights>2021. Elsevier Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-f0addb20c52be26f811ea5ce48b29648f861d9daa1b9522aa9556ed4d39207743</citedby><cites>FETCH-LOGICAL-c459t-f0addb20c52be26f811ea5ce48b29648f861d9daa1b9522aa9556ed4d39207743</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2513187635?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33865495$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Galli, Mattia</creatorcontrib><creatorcontrib>Benenati, Stefano</creatorcontrib><creatorcontrib>Capodanno, Davide</creatorcontrib><creatorcontrib>Franchi, Francesco</creatorcontrib><creatorcontrib>Rollini, Fabiana</creatorcontrib><creatorcontrib>D'Amario, Domenico</creatorcontrib><creatorcontrib>Porto, Italo</creatorcontrib><creatorcontrib>Angiolillo, Dominick J</creatorcontrib><title>Guided versus standard antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><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.</description><subject>Acute coronary syndromes</subject><subject>Angioplasty</subject><subject>Antiplatelet therapy</subject><subject>Bias</subject><subject>Bleeding</subject><subject>Blood platelets</subject><subject>Cardiology</subject><subject>Cerebral infarction</subject><subject>Clinical trials</subject><subject>Collaboration</subject><subject>Death</subject><subject>Design</subject><subject>Estimates</subject><subject>Genetic screening</subject><subject>Heart attacks</subject><subject>Heterogeneity</subject><subject>Implants</subject><subject>Intervention</subject><subject>Investigations</subject><subject>Meta-analysis</subject><subject>Model testing</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Observational studies</subject><subject>Pharmacodynamics</subject><subject>Platelets</subject><subject>Reduction</subject><subject>Risk assessment</subject><subject>Safety</subject><subject>Sensitivity analysis</subject><subject>Statistical analysis</subject><subject>Stents</subject><subject>Stroke</subject><subject>Systematic 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versus standard antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis</title><author>Galli, Mattia ; Benenati, Stefano ; Capodanno, Davide ; Franchi, Francesco ; Rollini, Fabiana ; D'Amario, Domenico ; Porto, Italo ; Angiolillo, Dominick J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-f0addb20c52be26f811ea5ce48b29648f861d9daa1b9522aa9556ed4d39207743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute coronary syndromes</topic><topic>Angioplasty</topic><topic>Antiplatelet therapy</topic><topic>Bias</topic><topic>Bleeding</topic><topic>Blood platelets</topic><topic>Cardiology</topic><topic>Cerebral infarction</topic><topic>Clinical trials</topic><topic>Collaboration</topic><topic>Death</topic><topic>Design</topic><topic>Estimates</topic><topic>Genetic screening</topic><topic>Heart attacks</topic><topic>Heterogeneity</topic><topic>Implants</topic><topic>Intervention</topic><topic>Investigations</topic><topic>Meta-analysis</topic><topic>Model testing</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Observational studies</topic><topic>Pharmacodynamics</topic><topic>Platelets</topic><topic>Reduction</topic><topic>Risk assessment</topic><topic>Safety</topic><topic>Sensitivity analysis</topic><topic>Statistical analysis</topic><topic>Stents</topic><topic>Stroke</topic><topic>Systematic review</topic><topic>Therapy</topic><topic>Thromboembolism</topic><topic>Thrombosis</topic><topic>Tradeoffs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Galli, Mattia</creatorcontrib><creatorcontrib>Benenati, Stefano</creatorcontrib><creatorcontrib>Capodanno, Davide</creatorcontrib><creatorcontrib>Franchi, Francesco</creatorcontrib><creatorcontrib>Rollini, Fabiana</creatorcontrib><creatorcontrib>D'Amario, 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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.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>33865495</pmid><doi>10.1016/S0140-6736(21)00533-X</doi><tpages>14</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0140-6736 |
| ispartof | The Lancet (British edition), 2021-04, Vol.397 (10283), p.1470-1483 |
| issn | 0140-6736 1474-547X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2515064233 |
| source | ScienceDirect Journals (5 years ago - present); ProQuest Central UK/Ireland |
| subjects | Acute coronary syndromes Angioplasty Antiplatelet therapy Bias Bleeding Blood platelets Cardiology Cerebral infarction Clinical trials Collaboration Death Design Estimates Genetic screening Heart attacks Heterogeneity Implants Intervention Investigations Meta-analysis Model testing Mortality Myocardial infarction Observational studies Pharmacodynamics Platelets Reduction Risk assessment Safety Sensitivity analysis Statistical analysis Stents Stroke Systematic review Therapy Thromboembolism Thrombosis Tradeoffs |
| title | Guided versus standard antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-18T17%3A01%3A16IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Guided%20versus%20standard%20antiplatelet%20therapy%20in%20patients%20undergoing%20percutaneous%20coronary%20intervention:%20a%20systematic%20review%20and%20meta-analysis&rft.jtitle=The%20Lancet%20(British%20edition)&rft.au=Galli,%20Mattia&rft.date=2021-04-17&rft.volume=397&rft.issue=10283&rft.spage=1470&rft.epage=1483&rft.pages=1470-1483&rft.issn=0140-6736&rft.eissn=1474-547X&rft_id=info:doi/10.1016/S0140-6736(21)00533-X&rft_dat=%3Cproquest_cross%3E2515064233%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2513187635&rft_id=info:pmid/33865495&rft_els_id=S014067362100533X&rfr_iscdi=true |