The clinical efficacy and safety evaluation of ticagrelor for acute coronary syndrome in general ACS patients and diabetic patients: A systematic review and meta-analysis.

In this study, a systematic evaluation was conducted to estimate the efficacy and safety of ticagrelor for treating acute coronary syndrome (ACS) in general ACS patients and a diabetes mellitus (DM) group.A search of PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CNKI databases was conducted to analyze relevant randomized controlled trails (RCTs) of ticagrelor treating ACS during 2007 to 2015. Article screening, quality accessing and data extracting was independently undertaken by two reviewers. A meta-analysis was performed to clarify the efficacy and safety of ticagrelor in general ACS patients, and a meta-regression analysis was taken to demonstrate the efficacy and safety of ticagrelor in DM patients compared with general ACS patients.Twenty-two studies with 35004 participants were included. The meta-analysis result implicated that ticagrelor could: 1) reduce the incidence of the composite endpoint [OR = 0.83, 95%CI (0.77, 0.90), P<0.00001] and the incidence of myocardial infarction [OR = 0.81, 95%CI (0.74, 0.89), P = 0.0001]; 2) not statistically reduce the incidence of cardiovascular death, the incidence of stroke and the incidence of bleeding events; 3) increase the incidence of dyspnea [OR = 1.90, 95%CI (1.73, 2.08), P<0.00001] compared with clopidogrel. Meanwhile, compared with prasugrel, ticagrelor could 1) reduce the platelet reactivity of patients at maintenance dose [MD = -44.59, 95%CI (-59.16, -30.02), P<0.00001]; 2) not statistically reduce the incidence of cardiovascular death, the platelet reactivity of patients 6 hours or 8 hours after administration, or the incidence of bleeding events; 3) induce the incidence of dyspnea [OR = 13.99, 95%CI (2.58, 75.92), P = 0.002]. Furthermore, the result of meta-regression analysis implicated that there was a positive correlation between DM patients and the platelet reactivity of patients 6 hours and 8 hours after administration, but there was no obvious correlation between DM patients and general ACS patients in other endpoints.Ticagrelor could reduce the incidence of composite endpoint of cardiovascular death, myocardial infarction and stroke as well as platelet reactivity in DM patients with ACS, while not increasing the risk of bleeding. Because there are differences in platelet reactivity between DM patients and general ACS patients, we suggest that caution is needed when using ticagrelor in clinical applications

Risk of bias summary.

<p>Risk of bias summary.</p

Risk of bias graph.

<p>Risk of bias graph.</p

Forest plots of platelet reactivity.

<p>(A) Platelet reactivity 6 hours after administration; (B) Platelet reactivity 8 hours after administration; (C) Platelet reactivity at maintenance dose.</p

Scatter plots of meta-regression analysis.

<p>(A) Incidence of composite endpoint; (B) Incidence of myocardial infarction; (C) Incidence of cardiovascular death; (D) Incidence of stroke; (E) Platelet reactivity 6 hours after administration; (F) Platelet reactivity 8 hours after administration; (G) Platelet reactivity at maintenance dose; (H) Incidence of bleeding events; (I) Incidence of dyspnea.</p

Forest plots of safety endpoint.

<p>(A) Incidence of bleeding events; (B) Incidence of dyspnea.</p

Forest plot of incidence of composite endpoint in ticagrelor and clopidogrel group.

<p>Forest plot of incidence of composite endpoint in ticagrelor and clopidogrel group.</p

Characteristics of included studies.

<p>Characteristics of included studies.</p

Process and results of study selection.

<p>Process and results of study selection.</p

Forest plots of MI, CVD and stoke.

<p>(A) Incidence of myocardial infarction; (B) Incidence of cardiovascular death; (C) Incidence of stroke.</p