Clinical study on dual antiplatelet therapy with ciopidogrel and aspirin in patients with ST-segment elevation acute myocardial infarction: a systematic review / 中华老年医学杂志

ABSTRACT

Objective To evaluate the effectivity and safety of dual antiplatelet therapy with clopidogrel and aspirin in patients with ST-segment elevation acute yocardial infarction(AMI).Methods We searched for randomized controlled trials(RCTs)and quasi-RCTs in the following electronic databasesPubMed,EMBASE,The Cochrane Library(Issue 3,2007),CBM,CNKI,VIP and Wanfang.Quality assessment and data extraction were conducted by two reviewers independently.Disagreement were resolved through discussion.All data were analyzed by using Review Manager 4.2. Results Ten studies involving a total of 52 433 participants met the inclusion criteria.Metaanalysis results showed that(1)Compared with aspirin alone,the incidence rates of death caused by any reason(RR=0.91,95% CI0.85～0.97),recurrent myocardial infarction(RR=0.80,95% CI0.72～0.89),stroke(RR=0.81,95% CI0.68～0.96),post-infarction angina(RR=0.35,95% CI0.19～0.66),incoronary thrombus(RR=0.73,95% CI0.64～0.83)and the combined endpoint events of death,reinfarction or stroke(RR=0.89,95% CI0.84～0.95)could be reduced by clopidogrel and aspirin.(2)There were no significant differences in ameliorating the cardiac function and increasing TIMI blood flow of infarct-related artery between the two groups RR=0.97,95% CI0.92～1.03;RR=1.14,95% CI1.00～1.30;both P＞0.05.(3)There was no significant difference in bleeding between the tWO groups(RR=1.11,95% CI0.92～1.34). Conclusions Compared with aspirin alone,clopidogrel plus aspirin has good effects on reducing the incidence rates of death caused by any reason,recurrent myocardial infarction,stroke,post-infarction angina,incoronary thrombus and the combined endpoint events of death,reinfarction or stroke in patients with ST-segment elevation AMI,and it has the same efficacy in ameliorating the cardiac function,increasing TIMI blood flow of infarct-related artery and bleeding.