title: Efficacy and safety analysis of new P2Y12 inhibitors versus clopidogrel in patients with percutaneous coronary intervention: a meta-analysis.
abstract: OBJECTIVE
  New P2Y12 inhibitors, classified as oral (prasugrel and ticagrelor) and intravenous (cangrelor and elinogrel) drugs, have shown improved antithrombotic effects compared with clopidogrel in patients with acute coronary syndrome (ACS) or patients undergoing percutaneous coronary intervention (PCI) in landmark trials. The purpose of this study was to perform a meta-analysis of randomized trials that compared new P2Y12 inhibitors with clopidogrel to determine their efficacy and safety in patients undergoing PCI.
  
  
  METHODS
  Randomized controlled trials of at least 4 weeks, comparing new P2Y12 inhibitors with clopidogrel in PCI, were identified using the electronic databases Cochrane Central Register of Controlled Trials, Medline, PubMed, Web of Science, and Google Scholar from January 1, 1980, to July 31, 2014.
  
  
  METHODS
  The primary efficacy endpoints were all-cause death and major adverse cardiovascular events (MACEs). The primary safety endpoint was thrombolysis in myocardial infarction (TIMI) major bleeding.
  
  
  RESULTS
  Twelve studies including 71,097 patients met the inclusion criteria. New P2Y12 inhibitors significantly reduced all-cause death (odds ratio [OR]: 0.81; 95% confidence interval [CI] 0.73-0.90, p < 0.0001), MACEs (OR 0.81; 95% CI 0.73-0.90, p < 0.0001), stent thrombosis (OR 0.58; 95% CI 0.49-0.69, p < 0.00001), myocardial infarctions (OR 0.87; 95% CI 0.76-0.99, p = 0.03) and cardiovascular death (OR 0.82; 95% CI 0.73-0.92, p = 0.001) compared with clopidogrel. There were no significant differences between stroke (OR 0.87; 95% CI 0.72-1.05, p = 0.14) and major bleeding events (OR 1.22; 95% CI 0.99-1.52, p = 0.06) between the new P2Y12 inhibitor and clopidogrel groups.
  
  
  CONCLUSIONS
  New P2Y12 inhibitors decreased death in patients undergoing PCI compared with clopidogrel with a considerable safety and tolerability profile; however, the risk/benefit ratio of ischemic and bleeding events should be further investigated.
authors.affiliation: a a Department of Cardiology , Zhongnan Hospital of Wuhan University , Wuhan City, Hubei Province , China.
authors.forename: Xue-Dong
authors.initials: XD
authors.lastname: Gan
authors.affiliation: a a Department of Cardiology , Zhongnan Hospital of Wuhan University , Wuhan City, Hubei Province , China.
authors.forename: Bao-Zhu
authors.initials: BZ
authors.lastname: Wei
authors.affiliation: a a Department of Cardiology , Zhongnan Hospital of Wuhan University , Wuhan City, Hubei Province , China.
authors.forename: Dong
authors.initials: D
authors.lastname: Fang
authors.affiliation: a a Department of Cardiology , Zhongnan Hospital of Wuhan University , Wuhan City, Hubei Province , China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Fang
authors.affiliation: a a Department of Cardiology , Zhongnan Hospital of Wuhan University , Wuhan City, Hubei Province , China.
authors.forename: Kai-Yong
authors.initials: KY
authors.lastname: Li
authors.affiliation: a a Department of Cardiology , Zhongnan Hospital of Wuhan University , Wuhan City, Hubei Province , China.
authors.forename: Shi-Lan-Ying
authors.initials: SL
authors.lastname: Ding
authors.affiliation: a a Department of Cardiology , Zhongnan Hospital of Wuhan University , Wuhan City, Hubei Province , China.
authors.forename: Song
authors.initials: S
authors.lastname: Peng
authors.affiliation: a a Department of Cardiology , Zhongnan Hospital of Wuhan University , Wuhan City, Hubei Province , China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wan
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy; D000077144:Clopidogrel; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Acute coronary syndrome; Clopidogrel; Meta-analysis; New P2Y12 inhibitors; Percutaneous coronary intervention; Randomized clinical trial