RESUMEN
To evaluate whether genotype-guided antiplatelet therapy reduces the rates of cardiovascular events and bleeding events in patients with acute coronary syndrome (ACS). We systematically searched Pubmed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) (searched in September 2018) for controlled studies evaluating genotype-guided antiplatelet therapy in ACS with percutaneous coronary intervention (PCI) or without PCI. The primary endpoint was a composite of death, myocardial infarction (MI), stroke, targeted vessel revascularization and/or major bleeding. A total of five studies involving 2900 patients were included. Compared with the conventional group, the genotype-guided group had a decreased risk of primary composite outcomes (RR= 0.54; 95% CI: 0.41-0.72; I2 = 30%), death (RR = 0.54; 95% CI: 0.32-0.94; I2 = 21%), MI (RR = 0.52; 95% CI: 0.31-0.88; I2 = 49%), targeted vessel revascularization (RR = 0.59; 95% CI: 0.35-0.98; I2 = 0%), but not for stroke (RR = 0.53; 95% CI: 0.22-1.24; I2 = 0%) and bleeding events (RR = 0.80; 95% CI: 0.51-1.25; I2 = 33%). Genotype-guided strategies could reduce the rates of cardiovascular events without increasing bleeding events compared with conventional treatment in ACS. Future multi-centre genotype-based randomized control trials are required to confirm these findings.
Asunto(s)
Síndrome Coronario Agudo/tratamiento farmacológico , Citocromo P-450 CYP2C19/genética , Hemorragia/tratamiento farmacológico , Infarto del Miocardio/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Trombosis/tratamiento farmacológico , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/genética , Síndrome Coronario Agudo/mortalidad , Aspirina/uso terapéutico , Plaquetas , Revascularización Cerebral/métodos , Clopidogrel/uso terapéutico , Expresión Génica , Genotipo , Hemorragia/etiología , Hemorragia/genética , Hemorragia/mortalidad , Humanos , Infarto del Miocardio/etiología , Infarto del Miocardio/genética , Infarto del Miocardio/mortalidad , Intervención Coronaria Percutánea/métodos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/genética , Accidente Cerebrovascular/mortalidad , Análisis de Supervivencia , Trombosis/complicaciones , Trombosis/genética , Trombosis/mortalidadRESUMEN
Background: Intracerebral hemorrhage (ICH) is the most feared complication of mechanical thrombectomy (MT). This study aims to provide a comprehensive overview of ICH risk factors. Methods: The authors systematically searched Pubmed and Embase (from inception to November 2018) for studies evaluating independent predictors for symptomatic ICH (sICH), parenchymal hematoma (PH), hemorrhagic infarction (HI), and any ICH after MT. Results: This analysis included a total of 42 studies involving 10,001 patients. The combined rate was 8% (7-10%) for sICH, 13% (10-15%) for PH, 25% (20-29%) for HI, and 35% (31-39%) for any ICH. Meta-analysis identified the following predictors of sICH: female sex (OR 2.98, 95%CI 1.23-7.25, I2 = 26.3%), treatment interval (OR 1.01, 95%CI 1-1.03, I2 = 69.20%), tirofiban use (OR 3.16, 95%CI 2.11-4.73, I2 = 0%), and ASPECTS score on admission (OR 0.63, 95%CI 0.54-0.74, I2 = 0%). Predictors of any ICH were diabetes mellitus (OR 1.95, 95%CI 1.29-2.94, I2 = 35.7%), deep white matter on diffusion-weighted imaging (OR 3.11, 95%CI 1.56-6.20, I2 = 0%), and intravenous recombinant tissue plasminogen activator (rt-PA) (OR 2.57, 95%CI 1.28-5.17, I2 = 0%). Conclusion: Many predictors of ICH were identified, however, given the lack of robust evidence, larger cohort studies should be prioritized to confirm these predictors.