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Published on: March 15, 2022
Benefits of laboratory personalized antiplatelet therapy in patients undergoing percutaneous coronary intervention: A
Yong Zhang, Pei Zhang, Zhan Li
1Department of Cardiology, Shandong Provincial Qianfoshan Hospital Affiliated to Shandong University. abrahamzhangy@hotmail.com.
Insights
Laboratory personalized antiplatelet therapy (PAPT) significantly reduces major adverse cardiac events (MACEs) and stent thrombosis in coronary artery disease patients after stenting. This strategy, incorporating genetic and platelet function testing, offers a valuable approach to improving patient outcomes.
Area of Science:
- Cardiology
- Pharmacogenomics
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) patients undergoing stenting often face risks of major adverse cardiac events (MACEs) and bleeding.
- Personalized antiplatelet therapy (PAPT) strategies, including genetic detection and platelet function testing (PFT), aim to mitigate these risks.
- Previous studies on laboratory PAPT's efficacy have yielded inconclusive results.
Purpose of the Study:
- To conduct a meta-analysis to precisely estimate the benefits of laboratory PAPT in CAD patients post-stenting.
- To evaluate the impact of PAPT on MACEs, stent thrombosis, myocardial infarctions, cardiovascular death, bleeding events, and ischemic stroke.
Main Methods:
- A systematic search of randomized controlled trials was performed using PubMed, Embase, and Cochrane Controlled Trials Register up to May 2017.
- Data from 14 studies, including 9497 patients, were pooled for meta-analysis.
Main Results:
- Laboratory PAPT significantly reduced the risk of MACEs (RR 0.58), stent thrombosis (RR 0.60), and myocardial infarctions (RR 0.43) compared to non-PAPT.
- No significant differences were found in cardiovascular death, bleeding events, or ischemic stroke.
- The preventive effect on MACEs was more pronounced in patients with high on-treatment platelet reactivity (RR 0.46).
Conclusions:
- Laboratory PAPT is beneficial for coronary artery disease patients following stenting.
- This personalized approach can effectively reduce thrombotic events.
- Further research may refine PAPT application in specific patient subgroups.
Background:
The preventive effects of laboratory personalized antiplatelet therapy (PAPT) strategy in-cluding genetic detection and platelet function testing (PFT) on major adverse cardiac events (MACEs) and bleeding events in coronary artery disease (CAD) patients undergoing stenting has been extensively studied. Despite that, no clear conclusion can be drawn. In this study, a meta-analysis was performed to explore a more precise estimation of the benefits of laboratory PAPT.
Methods:
Randomized controlled trials were identified by the use of search databases such as PubMed, Embase, and Cochrane Controlled Trials Register up to May 2017, and the estimates were pooled.
Results:
Fourteen studies including 9497 patients met the inclusion criteria. The laboratory PAPT reduced MACEs risk (risk ratio [RR] 0.58, 95% confidence interval [CI] 0.42-0.80, p = 0.001), stent thrombosis (RR 0.60, 95% CI 0.41-0.87, p = 0.008) and myocardial infarctions (RR 0.43, 95% CI 0.21-0.88, p = 0.02) compared to the non-PAPT group. No statistically significant difference was observed between the two groups regarding cardiovascular death (RR 0.77, 95% CI 0.51-1.16, p = 0.21), bleeding events (RR 0.96, 95% CI 0.81-1.13, p = 0.59) and ischemic stroke (RR 0.81; 95% CI 0.39-1.66, p = 0.57). The preventive effect on MACEs was more significant in patients with high on-treatment platelet reactivity (RR 0.46; 95% CI 0.27-0.80, p = 0.006).
Conclusions:
Coronary artery disease patients after stenting could obtain benefits from laboratory PAPT. (Cardiol J 2018; 25, 1: 128-141).
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