Background
Methods
Search strategy
Selection criteria
Data extraction and quality assessment
Statistical analysis
Results
Data retrieval
Characteristics of the included studies
Study | Study type | Study period | Population | No. of patients | Mean age (year) | Clinical presentation | Treatment | Testing time | Testing standard | Definition of HTPR | Definition of LTPR | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Ticagrelor | Prasugrel | Ticagrelor | Prasugrel | ||||||||||
Alexopoulos 2014 [8] | cohrot study | NR | ACS undergoing PCI | T: 278 (232/46) | T: 60.6 ± 11.8 | STEMI: 154 | STEMI: 130 | 90 mg bid MD | 10 mg MD | 1 month post discharge | PRU | PRU > 208 | NR |
NSTEMI: 63 | |||||||||||||
P: 234 (200/34) | P: 58.4 ± 10.2 | NSTEMI: 69 | UA: 41 | ||||||||||
UA: 55 | |||||||||||||
Alexopoulos 2012 [7] | RCT | NR | ACS and HTPR patients undergoing PCI | T: 22 (19/3) | T: 61.3 ± 8.1 | STEMI: 8 | STEMI: 11 | 90 mg bid, 15 days | 10 mg QD, 15 days | 15 days of treatment | PRU | PRU ≥ 235 | NR |
NSTEMI: 7 | NSTEMI: 3 | ||||||||||||
P: 22 (18/4) | P: 58.3 ± 8.6 | UA: 8 | |||||||||||
UA: 7 | |||||||||||||
Alexopoulos 2013 [9] | RCT | 2012.06–2012.09 | ACS patients with DM | T: 15 (14/1) | T: 65.4 ± 7.7 | STEMI: 3 | STEMI: 4 | 90 mg bid, 15 days | 10 mg QD, 15 days | 15 days of treatment | PRU | PRU ≥ 230 | NR |
NSTEMI: 7 | NSTEMI: 4 | ||||||||||||
P: 15 (14/1) | P: 60.9 ± 8.0 | UA: 7 | |||||||||||
UA: 5 | |||||||||||||
Deharo 2013 [11] | RCT | 2013.03–2013.06 | patients admitted for ACS | 96 (78/18) | 60.8 ± 9.8 | NR | NR | 90 mg bid | 10 mg QD | 1 month after ACS | PRI VASP | PRI VASP≥50% | PRI VASP ≤20% |
T: 48; P: 48 | |||||||||||||
Deharo 2014 [12] | RCT | 2013.03–2013.12 | patients admitted for ACS | T: 93; P: 93 | NR | NR | NR | 90 mg bid | 10 mg QD | 1 month after ACS | PRI VASP | PRI VASP≥50% | PRI VASP ≤20% |
Dillinger 2014 [13] | cohrot study | NR | consecutive patients admitted for ACS | T: 119 | 59 | NR | NR | NR | NR | during the hospitalization for ACS | PRI VASP | NR | VASP-PRI < 16% |
P: 268 | |||||||||||||
Franchi 2016 [14] | RCT | 2014.03–2015.10 | underwent PCI in the setting of an ACS | T-M: 27 (20/7) | T-M: 57 ± 7 | NR | NR | T-M: 90 mg bid MD | 10 mg QD MD | 1 week after randomization | PRU | PRU > 208, PRI > 50% | NR |
T: 54.8 ± 10.5 | PRI-VASP | ||||||||||||
T: 25 (21/4) | |||||||||||||
P: 57 ± 6.9 | |||||||||||||
P: 27 (21/6) | |||||||||||||
Guimaraes 2017 [28] | RCT | 2013.07–2015.12 | Patients with STEMI | T: 25 (18/7) | T: 52.2 ± 8.1 | STEMI | STEMI | 90 mg MD bid | 60 mg LD | 24 h after inclusion | PRU | NR | NR |
P: 55.5 ± 8.3 | |||||||||||||
P: 25 (22/3) | |||||||||||||
Kerneis 2015 [15] | cohrot study | NR | Patients with STEMI underwent PCI | T: 58 (49/9) | T: 59.97 ± 1.54 | STEMI | STEMI | 90 mg MD bid | 10 mg MD QD | 30 d after primary PCI | PRU, VASP-PRI | VASP-PRI > 50%, | VASP-PRI < 16% |
PRU < 85 | |||||||||||||
P: 60 (49/11) | P: 57.78 ± 1.37 | PRU > 208 | |||||||||||
Laine 2014 [16] | RCT | 2012.10–2013.02 | DM patients undergoing PCI for an ACS | T: 50 (33/17) | T: 64.8 ± 8.9 | STEMI or NSTEMI: 41 | STEMI/NSTEMI: 40 | 180 mg LD, 90 mg BID MD | 60 mg LD, 10 mg QD MD | 6–18 h post-LD | VASP | VASP> 50 and 61% | VASP< 16% |
P: 62.8 ± 8.2 | |||||||||||||
P: 50 (43/7) | UA: 10 | ||||||||||||
UA: 9 | |||||||||||||
Laine 2015 [17] | RCT | 2012.08–2013.06 | STEMI patients with ongoing ischemia admitted for primary PCI | T: 44 (40/4) | T: 57.4 ± 9.8 | STEMI | STEMI | 180 mg LD | 60 mg LD | 6-12 h after the LD and before the first MD | VASP | VASP≥50% | VASP< 16% |
P: 54.7 ± 8.3 | |||||||||||||
P: 44 (37/7) | |||||||||||||
lhermusier 2014 [18] | RCT | 2012.11–2013.06 | Patients admitted for ACS | T: 10 (10/0) | T:75(70–78) | NR | NR | 90 mg bid | 10 mg bid | 24 h ± 4 after inclusion | PRU, PRI- VASP | PRU ≥ 208 | NR |
PRI ≥50% | |||||||||||||
P: 10 (9/1) | P: 64 (52–68) | ||||||||||||
Parodi 2013 [19] | RCT | NR | STEMI patients undergoing primary PCI | T: 25 (19/6) | T: 67 ± 10 | STEMI | STEMI | 180 mg LD | 60 mg LD | 2 h after LD | PRU | PRU ≥240 | NR |
P: 67 ± 14 | |||||||||||||
P: 25 (20/5) | |||||||||||||
Yudi 2016 [21] | cohort study | 2009.07–2013.11 | consecutive ACS patients | T: 526 (411/115) | T: 61.7 ± 11.8 | STEMI: 288 | STEMI: 230 | NR | NR | NR | NR | NR | NR |
NSTEMI: 138 | |||||||||||||
P: 368 (317/51) | P: 57.1 ± 9.7 | NSTEMI: 238 |
Quality assessment
Cohort | Representativeness of the exposed cohort | Selection of the unexposed cohort | Ascertainment of exposure | Outcome of interest not present at start of study | Control for important factor or additional factorb | Outcome assessment | Follow-up long enough for outcomes to occur | Adequacy of follow-up of cohortsc | Total quality scores |
---|---|---|---|---|---|---|---|---|---|
Alexopoulos 2014 [8] | ☆ | ☆ | ☆ | ☆ | ☆ | ☆ | ☆ | ☆ | 8 |
Dillinger 2014 [13] | ☆ | ☆ | ☆ | ☆ | ☆ | ☆ | ☆ | ☆ | 8 |
Kerneis 2015 [15] | ☆ | ☆ | ☆ | – | ☆ | ☆ | ☆ | ☆ | 7 |
Yudi 2016 [21] | ☆ | ☆ | ☆ | ☆ | – | ☆ | – | – | 5 |
PR assessment
No. of studies | Heterogeneity test | Effect size | |||
---|---|---|---|---|---|
I2 (%) | PH | WMD/RR (95% CI) | P | ||
Platelet reactivity (PRU) | |||||
Type of studies | |||||
RCT | 5 | 86 | < 0.001 | −29.93 (−70.21, 10.36) | 0.15 |
Cohort | 2 | 87 | 0.005 | −37.55 (−65.66, −9.44) | 0.009 |
Testing time | |||||
< 24 h after the loading dose | 3 | 87 | 0.005 | −22.48 (−105.72, 60.76) | 0.60 |
5–30 days after initiation of treatment | 4 | 76 | 0.006 | −36.72 (−57.04, −16.40) | < 0.001 |
Special Population | |||||
STEMI | 3 | 67 | 0.05 | −5.77 (−34.85, −23.31) | 0.70 |
Diabetic patients | 1 | – | – | − 10.90 (−43.61, 21.81) | 0.514 |
Platelet reactivity (PRI) | |||||
Type of studies | |||||
RCT | 5 | 88 | < 0.001 | −10.51 (− 16.17, −4.85) | < 0.001 |
Cohort | 2 | 0 | 0.319 | −5.36 (−9.97, −0.76) | 0.023 |
Testing time | |||||
< 24 h after the loading dose | 3 | 89 | < 0.001 | −10.30 (−19.70, −0.90) | 0.032 |
5–30 days after initiation of treatment | 4 | 81 | < 0.001 | −8.91 (−15.03, −2.79) | 0.004 |
Special Population | |||||
STEMI | 2 | 0 | 0.650 | −3.69 (−7.63, 0.26) | 0.067 |
Diabetic patients | 1 | – | – | −10.40 (−17.96, −2.84) | 0.007 |
HTPR rates (PRU) a | |||||
Type of studies | |||||
RCT | 1 | – | – | 5.00 (0.25, 99.51) | 0.29 |
Cohort | 1 | – | – | 0.03 (0.00, 0.52) | 0.016 |
Testing time | |||||
5–30 days after initiation of treatment | 2 | 84 | 0.01 | 0.39 (0.001, 62.72) | 0.71 |
HTPR rates (PRI) | |||||
Type of studies | |||||
RCT | 5 | 20 | 0.290 | 0.30 (0.12, 0.75) | 0.010 |
Testing time | |||||
< 24 h after the loading dose | 2 | 0 | 0.440 | 0.31 (0.10, 0.98) | 0.047 |
5–30 days after initiation of treatment | 3 | 69 | 0.073 | 0.24 (0.03, 2.08) | 0.197 |
Special Population | |||||
STEMI | 1 | – | – | 0.11 (0.01, 2.00) | 0.137 |
Diabetic patients | 1 | – | – | 0.38 (0.11, 1.33) | 0.129 |
LTPR rates (PRI) | |||||
Type of studies | |||||
RCT | 4 | 82 | 0.0008 | 1.63 (0.95, 2.80) | 0.073 |
Cohort | 2 | 85 | 0.009 | 1.31 (0.98, 1.76) | 0.066 |
Testing time | |||||
< 24 h after the loading dose | 2 | 0 | 0.898 | 1.09 (0.86, 1.39) | 0.462 |
5–30 days after initiation of treatment | 4 | 89 | < 0.001 | 1.69 (1.12, 2.56) | 0.012 |
Special Population | |||||
STEMI | 2 | 0 | 0.634 | 1.15 (1.01, 1.30) | 0.029 |
Diabetic patients | 1 | – | – | 1.11 (0.79, 1.56) | 0.545 |