kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2019-8-4-26-36kpccz-628Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ. КардиологияORIGINAL STUDIES. CardiologyЭффективность персонализированной антитромботической терапии при стентировании коронарных артерий: мета-анализEffectiveness of personalized antiplatelet therapy in patients undergoing coronary stenting: meta-analysisГительзонД. Г.GitelsonD. G.

Ул. Миклухо-Маклая, 6, Москва, 117198; Новый Зыковский пр., 4, Москва, 125167

Gitelson Daniil G. - PhD student at the Surgical Department with a course of pediatric surgery, Medical Institute, ResearcherID: M-6423-2014

6, Miklukho-Maklaya St., Moscow, 117198

danielgitelson@gmail.comhttps://orcid.org/0000-0001-7998-3051ФайбушевичА. Г.FaibushevichA. G.

Файбушевич Александр Георгиевич - кандидат медицинских наук, заведующий кафедрой госпитальной хирургии с курсом детской хирургии Медицинского Института.

Ул. Миклухо-Маклая, 6, Москва, 117198

Faibushevich Alexander G. - Head of the Surgical Department with a course of pediatric surgery, Medical Institute; ORCID 0000-0001-7998-3051.

6, Miklukho-Maklaya St., Moscow, 117198

МаксимкинД. А.MaximkinD. A.

Максимкин Даниил Александрович - кандидат медицинских наук, доцент кафедры госпитальной хирургии с курсом детской хирургии Медицинского Института, ResearcherID: 5117-2019.

Ул. Миклухо-Маклая, 6, Москва, 117198

Maximkin Daniil A. - PhD, Associate Professor at the Surgical Department with a course of pediatric surgery, Medical Institute, ResearcherID: 5117-2019.

6, Miklukho-Maklaya St., Moscow, 117198

ВеретникГ. И.VeretnikG. I.

Веретник Галина Ивановна - кандидат медицинских наук, заведующая учебной частью кафедры госпитальной хирургии с курсом детской хирургии Медицинского Института, ResearcherlD: 5110-2019

Ул. Миклухо-Маклая, 6, Москва, 117198

Veretnik Galina I. - PhD, Curriculum Director of the Surgical Department with a course of pediatric surgery, Medical Institute, Researcher®: 5110-2019.

6, Miklukho-Maklaya St., Moscow, 117198

https://orcid.org/0000-0001-6550-1939ВасильевА. Э.VasilievA. E.

Васильев Александр Эдуардович - кандидат медицинских наук, врач рентгенэндоваскулярной диагностики и лечения, ResearcherlD: I-5192-2017.

Новый Зыковский пр., 4, Москва, 125167

VasilievAlexander E. - MD, PhD, interventional cardiologist, Researcher®: I-5192-2017.

4a, Novozykovskii proezd, Moscow, 125167

https://orcid.org/0000-0003-3871-5530ГительзонЕ. А.GitelzonE. A.

Гительзон Екатерина Александровна - аспирант кафедры госпитальной хирургии с курсом детской хирургии Медицинского Института, ResearcherlD: D-4758-2017.

Ул. Миклухо-Маклая, 6, Москва, 117198; Новый Зыковский пр., 4, Москва, 125167

Gitelson Ekaterina A. - PhD student at the Surgical Department with a course of pediatric surgery, Medical Institute.

6, Miklukho-Maklaya St., Moscow, 117198

https://orcid.org/0000-0002-1926-9021РоговД. А.RogovD. A.

Рогов Дмитрий Анатольевич - врач рентгенэндоваскулярной диагностики и лечения, ResearcherlD: D-8134-2017.

Новый Зыковский пр., 4, Москва, 125167

Rogov Dmitry A. - MD, interventional cardiologist, Researcher®: D-8134-2017.

4a, Novozykovskii proezd, Moscow, 125167

ДанишянК. И.DanishianK. I.

Данишян Карен Исмаилович, доктор медицинских наук, заведующий отделением хирургии.

Новый Зыковский пр., 4, Москва, 125167

Danishian Karen I. - PhD, Head of the Surgical Department.

4a, Novozykovskii proezd, Moscow, 125167

Федеральное государственное автономное образовательное учреждение высшего образования Российский университет дружбы народовРоссияRUDN University; National Hematology Research CenterRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования Российский университет дружбы народовРоссияRUDN UniversityRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр гематологии» Министерства здравоохранения Российской ФедерацииРоссияNational Hematology Research CenterRussian Federation201924122019842636Copyright © Гительзон Д.Г., Файбушевич А.Г., Максимкин Д.А., Веретник Г.И., Васильев А.Э., Гительзон Е.А., Рогов Д.А., Данишян К.И., 20192019Гительзон Д.Г., Файбушевич А.Г., Максимкин Д.А., Веретник Г.И., Васильев А.Э., Гительзон Е.А., Рогов Д.А., Данишян К.И.Gitelson D.G., Faibushevich A.G., Maximkin D.A., Veretnik G.I., Vasiliev A.E., Gitelzon E.A., Rogov D.A., Danishian K.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/628Основные положения

Основные положения. На основании данных рандомизированных контролируемых исследований получены доказательства эффективности персонализированной антитромботической терапии в снижении риска развития тромбоза стента, инфаркта миокарда и других серьезных кардиальных событий.

Актуальность

Актуальность. Активно изучается профилактика развития осложнений после стентирования коронарных артерий, путем подбора персонализированной антитромботической терапии (ПАТ) на основании оценки функции тромбоцитов и генетического анализа. Однако имеются разногласия по этой проблеме. В данной статье представлен метаанализ наиболее значимых исследований ПАТ.

Цель

Цель. Оценить эффективность персонализированной антитромботической терапии при стентировании коронарных артерий.

Материалы и методы               . Использовались данные рандомизированных контролируемых исследований из баз данных PubMed, Embase и CochraneLibrary.

Результаты

Результаты. Изучено пятнадцать исследований, всего 9 497 пациентов. По результатам метаанализа ПАТ снижает риск серьезных кардиальных событий (относительный риск (ОР) 0,58, 95% доверительный интервал (ДИ) 0,42-0,80, p = 0,001), тромбоза стента (ОР 0,60, 95% ДИ 0,41-0,87, p = 0,008) и инфаркта миокарда (ОР 0,43, 95% ДИ 0,21-0,88, p = 0,02) по сравнению с группой пациентов без ПАТ. Тем не менее, не было обнаружено значимого различия по сердечно-сосудистой смертности (ОР 0,77, 95% ДИ 0,51-1,16, p = 0,21), кровотечениям (ОР 0,96, 95% ДИ 0,81-1,13, p = 0,59) и ишемическому инсульту (ОР 0,81, 95% ДИ 0,39-1,66, p = 0,57). Эффективность ПАТ в снижении серьезных кардиальных событий проявлялась в основном у пациентов с высокой реактивностью тромбоцитов на фоне двойной антитромботической терапии (ОР 0,46, 95% ДИ 0,27-0,80, p = 0,006).

Заключение

Заключение. Персонализированная антитромботическая терапия статистически значимо снижает риск развития тромбоза стента, инфаркта миокарда и других серьезных кардиальных событий при стентировании ко онарных артерий.

Background

Background. Prevention of complications in patients after coronary stenting by selection of personalized antiplatelet therapy (PAPT) based on platelet function test and genetic analysis have been actively studied. However, it is still an issue of concern. The article presents a meta-analysis of the recent PAPT studies.

Aim

Aim. To evaluate the effectiveness of personalized antiplatelet therapy in patients undergoing coronary stenting.

Methods             Fifteen studies with the total of 9,497 patients were included in the meta-analysis. The PAPT studies were searched using the PubMed, Embase and Cochrane Library.

Results

Results. PAPT reduces the risk of major adverse cardiovascular events (RR 0.58, 95% CI 0.42-0.80, p = 0.001), stent thrombosis (RR 0.60, 95% CI 0.41-0.87, p = 0.008) and myocardial infarction (RR 0.43, 95% CI 0.21-0.88, p = 0.02) compared with patients without PAPT. However, no significant differences were found in cardiovascular mortality (RR 0.77, 95% CI 0.51-1.16, p = 0.21), bleeding (RR 0.96, 95% CI 0.81-1.13, p = 0.59) and ischemic stroke (RR 0.81, 95% CI 0.39-1.66, p = 0.57). The effectiveness of PAPT in reducing major adverse cardiovascular events was mainly in patients with high platelet reactivity during dual antiplatelet therapy (RR 0.46, 95% CI 0.27-0.80, p = 0.006).

Conclusion

Conclusion. Personalized antiplatelet therapy significantly reduces the risk of stent thrombosis, myocardial infarction and other major adverse cardiovascular events in patients with coronary artery stenting.

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The authors declare that there are no conflicts of interest present.