Prasugrel versus clopidogrel in acute coronary syndrome patients undergoing percutaneous coronary intervention:A meta-analysis of randomized controlled trials

ZHANG Bu-chun; CHE Wen-liang; LIU Wei-jing; XU Ya-wei

摘要：Background Clopidogrel is beneficial after acute coronary syndrome.Recent studies suggest the superiority of prasugrel compared with clopidogrel.The enhanced platelet inhibition with prasugrel lead to a reduction in major adverse cardiovascular events in patients with moderate to high risk acute coronary syndrome scheduled for PCI.However,prasugrel showed signs of increased bleeding potential.We performed a meta-analysis to assess clinical safety and efficacy of prasugrel in patients with acute coronary syndrome.Methods We systematically searched PubMed,ISI Web of Knowledge,Cochrane Central Register of Controlled Trials,clinicahrials,gov,proceedings of major US and European cardiology meetings,China National Knowledge Infrastructure(CNKI)databases 2000-2010 and reviews,reference lists of relevant articles.The search strategy paired the term"prasugrel""clopidogrel"with the following:"acute coronary syndrome""percutaneous coronary intervention"We conducted a meta-analysis of randomized double-blind trials that evaluated clinical outcomes in patients with acute coronary syndrome.Two reviewers independently assessed the trials.Differences were resolved by consensus.Results A total of 2 trials with 14512 patients were available for analysis.Overall,prasugrel appeared significantly superior to clopidogrel for the risk of MACE(OR =0.820.74-0.90,P < 0.0001),stent thrombosis(OR = 0.470.35-0.62,P < 0.00001),death(OR = 0.850.78-0.93,P =0.0003),and myocardial infarction(OR = 0.760.68-0.85,P < 0.00001),without any significant difference in stroke(P= 0.85).However,major bleeding associated with non coronary artery bypass grafting Thrombolysis in Myocardial Infarction related to prasugrel(OR = 1.321.03-1.67,P = 0.03).Condusions Prasugrel is superior to clopidogrel for acute coronary syndrome,while causing more bleedings.