| アブストラクト | BACKGROUND: Based on the landmark PLATO (Platelet Inhibition and Patient Outcomes) and TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction) trials, current guidelines recommend ticagrelor and prasugrel over clopidogrel for acute coronary syndrome. However, subsequent studies have failed to replicate the reported benefits of ticagrelor, raising concerns about the validity of the PLATO trial's findings. METHODS: Randomized trials published until January 2025 were searched on PubMed and Embase and included if they compared 2 of the 3 standard dual antiplatelet therapies: 12 months aspirin plus clopidogrel, prasugrel, or ticagrelor. We constructed a network with and without PLATO to assess its impact on the synthesized risk estimates on major adverse cardiovascular events, patient mortality, myocardial infarction, and stent thrombosis, as well as major bleeding and major or minor bleeding. RESULTS: Twelve trials, enrolling 52 415 patients (clopidogrel: 23 557; ticagrelor: 13 344, prasugrel: 15 514) were included. The analysis with PLATO showed lower hazard ratios for ticagrelor versus clopidogrel than the analysis without PLATO in major adverse cardiovascular events, mortality, myocardial infarction, and bleeding outcomes (e.g., cardiovascular mortality; hazard ratio [HR], 0.83 [95% CI, 0.72-0.96] when PLATO was included; HR, 0.96 [95% CI, 0.73-1.25] when PLATO was excluded). Ticagrelor and prasugrel were associated with higher incidences of major bleeding and major or minor bleeding for analyses including and excluding PLATO, altohugh the point estimates for ticagrelor were lower when PLATO was included. CONCLUSIONS: The pooled estimates with PLATO favored ticagrelor compared with estimates without PLATO in several studied outcomes, potentially suggesting the substantial impacts of PLATO's findings on the pooled risk estimates; therefore, additional evidence may be needed given the large number of patients worldwide treated with dual antiplatelet therapy. |
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| ジャーナル名 | Journal of the American Heart Association |
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| Pubmed追加日 | 2025/8/23 |
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| 投稿者 | Watanabe, Atsuyuki; Aikawa, Tadao; Miyamoto, Yoshihisa; Ueyama, Hiroki A; Fujisaki, Tomohiro; Shoji, Satoshi; Hosseini, Kaveh; Slipczuk, Leandro; Briasoulis, Alexandros; Kampaktsis, Polydoros N; Wiley, Jose; Secemsky, Eric A; Iwagami, Masao; Tsugawa, Yusuke; Kuno, Toshiki |
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| 組織名 | Department of Medicine, Mount Sinai Morningside and West Icahn School of Medicine;at Mount Sinai New York NY USA.;Department of Cardiovascular Biology and Medicine Juntendo University Graduate;School of Medicine Tokyo Japan.;Department of Real-World Evidence, Graduate School of Medicine University of;Tokyo Bunkyo City Japan.;Division of Cardiology Emory University School of Medicine Atlanta GA USA.;Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center;Osaka Japan.;Department of Cardiovascular Medicine, Graduate School of Medical Sciences;Kumamoto University Kumamoto Japan.;Duke Clinical Research Institute Durham NC USA.;Tehran Heart Center, Cardiovascular Diseases Research Institute Tehran University;of Medical Sciences Tehran Iran.;Cardiology Division Montefiore Medical Center/Albert Einstein College of Medicine;Bronx NY USA.;Section of Heart Failure University of Iowa Iowa City IA USA.;Structural and Congenital Center Hackensack University Medical Center Hackensack;NJ USA.;Section of Cardiology, Department of Medicine Tulane University School of;Medicine New Orleans LA USA.;Division of Cardiology Beth Israel Deaconess Medical Center Boston MA USA.;Department of Digital Health, Institute of Medicine University of Tsukuba Tsukuba;Japan.;Division of General Internal Medicine and Health Services Research David Geffen;School of Medicine at UCLA Los Angeles CA USA.;Department of Health Policy and Management UCLA Fielding School of Public Health;Los Angeles CA USA.;Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston;MA USA. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/40847484/ |
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