From: A brief review on resistance to P2Y12 receptor antagonism in coronary artery disease
Authors (year) | Study design | Population | No. studies (no. patients) | Drug and/or intervention | Lab method | Clinical outcome Risk Ratio (RR) or Odds ratio (OR) with 95% CI are mainly given |
---|---|---|---|---|---|---|
Zhou, Y. et al. (2017) [18] | Meta-analysis of RCTs | Patients with CAD undergoing PCI | 13 (7290) | CAT vs. IAT based on platelet function testing | VASP, VN, LTA, Multiplate | Testing-guided IAT was associated with a significant reduction in MACE [RR: 0.55 (0.36, 0.84), p = 0.005], CV death [RR: 0.60 (0.38–0.96), p = 0.03], ST [RR: 0.58 (0.36, 0.93), p = 0.02] and TVR [RR: 0.33 (0.14–0.76), p = 0.009] compared to CAT. No significant difference in rate of bleeding events. |
Xu, L. et al. (2016) [19] | Meta-analysis of RCTs | Patients with CAD undergoing PCI | 13 (5111) | CAT vs. IAT based on platelet function testing | VASP, VN, LTA, Multiplate, TEG | The incidences of CV death, nonfatal MI, and stent thrombosis were significantly lower in the IAT group than in the CAT group [RR: 0.45, (0.36, 0.57), p < 0.00001], whereas bleeding was similar between the two groups [RR: 1.05 (0.86, 1.27), p = 0.65]. |
Reny, J. et al. (2016) [20] | Meta-analysis of prospective cohorts and RCTs | Patients with symptomatic atherothrombosis | 13 (6478) | Clopidogrel | LTA | The strength of the association between PR and the risk of MACE increased significantly (p = 0.04) with the number of risk factors present (age > 75 years, ACS at inclusion, diabetes, and hypertension). No association was detected in patients with no risk factor (p = 0.48). |
Ma, W. et al. (2015) [21] | Meta-analysis of RCTs | Patients undergoing PCI | 17 (4822) | CAT vs. IAT with and without platelet function testing. | VASP, VN, LTA, Multiplate | IAT was generally associated with a significant reduction in the risk of MACE [OR: 0.52 (0.39, 0.71), p < 0.0001]. The subgroup with HPR did also benefit from IAT compared to CAT [OR: 0.54 (0.38, 0.77), p = 0.0007]. The observed benefits were mainly attributed to treatment-associated reduction in ST [OR: 0.43 (0.23, 0.78), p = 0.006] and TVR [OR: 0.38 (0.20, 0.74), p = 0.004]. No difference in the rate of major/minor bleeding event between IAT or CAT [OR: 0.80 (0.56, 1.13), p = 0.21]. |
Lin, L. et al. (2015) [22] | Meta-analysis of RCTs | Patients undergoing PCI | 8 (3865) | CAT vs. IAT in patients with HPR | VASP, VN, LTA, Multiplate | In patients with HPR, IAT significantly reduced the risk of MACE/MACCE [RR: 0.59 (0.39, 0.88), p = 0.01], CV death [RR: 0.33, (0.12, 0.97), p = 0.04], ST [RR: 0.43 (0.20, 0.92), p = 0.03], and TVR [RR 0.31 (0.10, 0.93), p = 0.04], without increasing major bleeding [RR 0.75 (0.43, 1.31), p = 0.31] compared with CAT. |
D’Ascenzo, F. et al. (2014) [23] | Meta-analysis | Patients with CAD | 26 (28178) | Aspirin vs. clopidogrel | VN, LTA, Multiplate, TEG, | HPR was reported in 29% of patients on clopidogrel. HPR was not an independent prognostic indicator of adverse cardiac events in patients with either stable and unstable coronary disease for adverse cardiac events. |
Chen, J. et al. (2013) [24] | Meta-analysis | Population with ACS | 8 (605) | Clopidogrel with and without PPI | VASP, VN, Multiplate | Compared to clopidogrel treatment alone, patients who received both a PPI and clopidogrel had less of a decrease in the PRI [WMD: 8.18 (6.81, 9.56), p < 0.00001], less ADP–induced platelet aggregation inhibition [WMD: 7.28 (2.44, 12.11), p = 0.003], higher PRU [WMD: 40.58 (19.31, 61.86), p = 0.0002], and higher risks of clopidogrel resistance [OR: 2.49 (1.49, 4.14), p = 0.0005]. However, no significant differences for the incidences of MACE were found. |