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Antithrombotic therapy in adults with ectatic coronary artery disease: a systematic review and network meta-analysis
Alireza Azarboo1,2, Mohammad Shahabaddin Daneshvar1,2, Alireza Sattari Abroy1,2
1Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Ave, Tehran, Iran.
Insights
Dual antiplatelet therapy (DAPT) is the most effective treatment for preventing major adverse cardiovascular events (MACE) in coronary artery ectasia (CAE). Aspirin monotherapy and anticoagulation also show benefits, but DAPT offers the best protection.
Area of Science:
- Cardiology
- Pharmacology
- Evidence-based medicine
Background:
- Coronary artery ectasia (CAE) management often involves antiplatelet or anticoagulant therapy to reduce major adverse cardiovascular events (MACE).
- Optimal antithrombotic treatment selection for CAE remains unclear, necessitating comparative efficacy analysis.
Purpose of the Study:
- To evaluate and compare the efficacy of various antithrombotic treatments in adult patients diagnosed with coronary artery ectasia (CAE).
- To identify the most effective antithrombotic strategy for preventing MACE in CAE patients through a systematic review and network meta-analysis.
Main Methods:
- Systematic review and network meta-analysis (NMA) following PRISMA guidelines, adhering to a PROSPERO-registered protocol.
- Searches conducted up to October 2024; study selection, data extraction, and risk-of-bias assessments performed by two independent reviewers.
- Pairwise meta-analysis and NMA compared MACE odds across different antithrombotic therapies versus no treatment.
Main Results:
- The review included 5,039 adult patients with CAE.
- Dual antiplatelet therapy (DAPT) and aspirin monotherapy significantly reduced MACE compared to no treatment.
- Anticoagulation showed a trend towards lower MACE, but did not reach statistical significance; DAPT emerged as the most effective intervention in NMA.
Conclusions:
- Dual antiplatelet therapy (DAPT) is the most effective treatment for preventing MACE in coronary artery ectasia (CAE) patients, supported by Surface Under the Cumulative Ranking Curve (SUCRA) values.
- Aspirin monotherapy and anticoagulant treatments are also beneficial, ranking below DAPT in efficacy.
- Findings provide evidence-based guidance for optimizing antithrombotic strategies in CAE management.
Background:
Many studies have validated the use of antiplatelet or anticoagulant therapy in coronary artery ectasia (CAE) to reduce major adverse cardiovascular events (MACE); however, it is not completely known which group of these antithrombotic medications is more effective. The purpose of this systematic review and network meta-analysis was to evaluate the efficacy of different anti-thrombotic treatments in adult patients with CAE.
Methods:
This systematic review and meta-analysis followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines as well as PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses and adhered to a registered predetermined methodology noted in the prospective register of systematic reviews (PROSPERO) protocol. Comprehensive searches were conducted until October 2024. Study selection, data extraction, and risk-of-bias assessments were independently performed by two reviewers. The pairwise meta-analysis compared the odds of MACE among patients receiving different antithrombotic therapies versus no treatment. The network meta-analysis (NMA) combined direct and indirect evidence to compare the efficacy of antithrombotic therapies for MACE.
Results:
Our systematic review included 5,039 adult patients suffering from CAE. The odds of MACE were higher in patients with no treatment when compared with those on dual antiplatelet therapy (DAPT) and aspirin monotherapy; although patients on anticoagulation demonstrated a lower incidence of MACE, the difference with the no treatment group did not reach statistical significance. Among various types of interventions in NMA, DAPT was the best in the treatment of CAE.
Conclusions:
Based on the surface under the cumulative ranking curve (SUCRA) value, DAPT is the most effective treatment in the prevention of MACE for CAE patients, followed by aspirin monotherapy and anticoagulant treatment.
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