Platelet reactivity-adjusted antiplatelet therapy in patients with percutaneous coronary intervention: a meta-analysis of randomized controlled trials.

ABSTRACT

Numerous number of evidences show that high on-treatment platelet reactivity is a well-known risk factor for adverse events in patients after percutaneous coronary intervention (PCI). Controversial situations still exist regarding the effectiveness of tailoring antiplatelet therapy according to platelet function monitoring. The PubMed, Embase, and Cochrane Central databases were searched for randomized trials comparing platelet reactivity-adjusted antiplatelet therapy with conventional antiplatelet therapy in patients undergoing PCI. The primary end point was all-cause mortality, major adverse cardiac events (MACE) including cardiovascular (CV) death, nonfatal myocardial infarction (MI), definite/probable stent thrombosis (ST), revascularization, and stroke or transient ischemic attack (TIA). The safety end point was defined as major bleeding events. We derived pooled risk ratios (RRs) with fixed-effect models. Six studies enrolling 6347 patients were included. Compared with conventional treatment, tailoring antiplatelet failed to reduce all-cause mortality (RR 0.89, 95% confidence interval [CI] 0.63-1.24, P = 0.48), MACE (RR 1.02, 95% CI 0.92-1.14, P = 0.69), MI (RR 1.07, 95% CI 0.95-1.21, P = 0.24), CV death (RR 0.69, 95% CI 0.40-1.19, P = 0.09), ST (RR 0.83, 95% CI 0.50-1.38, P = 0.23), stroke or TIA (RR 1.08, 95% CI 0.55-2.12, P = 0.83), revascularization (RR 0.96, 95% CI 0.69-1.33, P = 0.79), and major bleeding events (RR 0.79, 95% CI 0.53-1.17, P = 0.24). Compared with traditional antiplatelet treatment, tailoring antiplatelet therapy according to platelet reactivity testing failed to reduce all-cause mortality, MACE, and major bleeding events in patients undergoing PCI.