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Guided vs. conventional anti-platelet therapy for patients with acute coronary syndrome: A meta-analysis of

Peng-Yu Zhong1, Jian-Ping Deng1, Jing-Hong Zhao1

  • 1Department of Cardiology, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China.

Frontiers in Cardiovascular Medicine
|April 7, 2023
PubMed

Insights

Guided antiplatelet therapy significantly reduces major adverse cardiovascular events (MACE) and mortality in acute coronary syndrome (ACS) patients undergoing PCI. This strategy offers comparable bleeding risk to conventional therapy, improving net clinical benefits.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • The clinical benefit of guided antiplatelet therapy versus conventional therapy in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) remains debated.
  • This meta-analysis evaluates the safety and efficacy of guided antiplatelet therapy in this patient population.

Purpose of the Study:

  • To compare the net clinical benefit of guided antiplatelet therapy against conventional antiplatelet therapy in ACS patients undergoing PCI.
  • To assess the impact of guided therapy on major adverse cardiovascular events (MACE) and bleeding risk.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using PubMed, EMBASE, and Cochrane Library.
  • Seven RCTs involving 8,451 patients were included, comparing guided versus conventional antiplatelet therapy.
  • Primary outcomes included MACE and major bleeding; secondary outcomes included myocardial infarction, stent thrombosis, and mortality. Trial sequential analysis was performed.

Main Results:

  • Guided antiplatelet therapy significantly reduced MACE (RR 0.64, P<0.00001), myocardial infarction (RR 0.62, P=0.0001), all-cause death (RR 0.61, P=0.003), and cardiovascular death (RR 0.66, P=0.009).
  • No significant differences were observed in stent thrombosis (RR 0.67, P=0.07) or major bleeding (RR 0.86, P=0.27) between groups.
  • Subgroup analysis indicated that genotype-guided therapy improved MACE and myocardial infarction outcomes.

Conclusions:

  • Guided antiplatelet therapy demonstrates a lower risk of MACE, myocardial infarction, and mortality compared to conventional therapy in ACS patients.
  • The guided approach offers comparable safety regarding bleeding risk, suggesting improved net clinical benefit.
  • Genotype-guided therapy shows particular promise for reducing adverse cardiovascular events.
Abstract

Keywords:
acute coronary syndromedual antiplatelet therapygenotype testingpercutaneous coronary interventionplatelet function testing

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