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Meta-Analysis
. 2019 Apr 2;8(7):e010889.
doi: 10.1161/JAHA.118.010889.

Effectiveness and Safety of Platelet ADP -P2Y12 Receptor Inhibitors Influenced by Smoking Status: A Systematic Review and Meta-Analysis

Zhiyan Liu  1   2 , Qian Xiang  1 , Guangyan Mu  1 , Qiufen Xie  1 , Shuang Zhou  1 , Zining Wang  1 , Shuqing Chen  1 , Kun Hu  1 , Yanjun Gong  3 , Jie Jiang  3 , Yimin Cui  1   2
Affiliations
Meta-Analysis

Effectiveness and Safety of Platelet ADP -P2Y12 Receptor Inhibitors Influenced by Smoking Status: A Systematic Review and Meta-Analysis

Zhiyan Liu et al. J Am Heart Assoc. .

Abstract

Background As reports on the influence of cigarette smoking, an important cardiovascular risk factor, on platelet ADP -P2Y12 receptor inhibitors lack consistency, we aimed to assess the effectiveness and safety of platelet ADP -P2Y12 receptor inhibitors influenced by smoking status. Methods and Results PubMed, Web of Science, EMBASE , Clinical Trials, and the Cochrane Library were searched from inception until June 2018. Among the 5076 citations retrieved, 22 studies, including 163 011 patients with or without percutaneous coronary intervention, were included for meta-analysis. Compared with nonsmokers within the first year of follow-up, the reductions of stroke and major adverse cardiovascular event rate were 18% ( P=0.008) and 26% ( P=0.02), respectively. A 20% reduction in stroke ( P=0.02) and a 34% reduction in major adverse cardiovascular event ( P=0.0001) rates were observed in smoking patients without percutaneous coronary intervention. No significant difference was observed in clinical outcome rates among prasugrel, ticagrelor, and clopidogrel in different smoking status. No significant difference was found in myocardial infarction and bleeding event incidence between current smokers and nonsmokers. Conclusions We concluded that current smokers had a lower incidence of major adverse cardiovascular events and stroke events than did nonsmokers, particularly in the early period (1 year) and among patients without percutaneous coronary intervention. However, because of the lack of original adjusted data, smoker's paradox still needs to consider the impact of age and other covariates. Thus, a differential risk-benefit evaluation should be considered, according to different smoking status, patient conditions, and therapy time points.

Keywords: effectiveness; meta‐analysis; platelet aggregation inhibitors; safety; smoking.

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Figures

Figure 1
Figure 1
Flow diagram of study identification and selection. MACE indicates major adverse cardiovascular event; MI, myocardial infarction.
Figure 2
Figure 2
Forest plot of the effects of smoking status on myocardial infarction (MI) events.
Figure 3
Figure 3
Forest plot of the effects of smoking status on myocardial infarction (MI) events in patients with or without percutaneous coronary intervention (PCI) in <1 year of follow‐up.
Figure 4
Figure 4
Forest plot of the effects of smoking status on myocardial infarction events in the age subgroup analysis.
Figure 5
Figure 5
Forest plot of the effects of smoking status on myocardial infarction events in the race subgroup analysis.
Figure 6
Figure 6
Forest plot of the effects of smoking status on stroke events.
Figure 7
Figure 7
Forest plot of the effects of smoking status on stroke events in patients with or without percutaneous coronary intervention (PCI) in <1 year of follow‐up.
Figure 8
Figure 8
Forest plot of the effects of smoking status on stroke events in the age subgroup analysis.
Figure 9
Figure 9
Forest plot of the effects of smoking status on stroke events in the race subgroup analysis.
Figure 10
Figure 10
Forest plot of the effects of smoking status on death events.
Figure 11
Figure 11
Forest plot of the effects of smoking status on death events in the age subgroup analysis.
Figure 12
Figure 12
Forest plot of the effects of smoking status on death events in the race subgroup analysis.
Figure 13
Figure 13
Forest plot of the effects of smoking status on bleeding events.
Figure 14
Figure 14
Forest plot of the effects of smoking status on bleeding events in the age subgroup analysis.
Figure 15
Figure 15
Forest plot of the effects of smoking status on bleeding events in the race subgroup analysis.
Figure 16
Figure 16
Forest plot of the effects of smoking status on major adverse cardiovascular events (MACEs).
Figure 17
Figure 17
Forest plot of the effects of smoking status on major adverse cardiovascular events (MACEs) in patients with or without percutaneous coronary intervention (PCI) in <1 year of follow‐up.
Figure 18
Figure 18
Forest plot of the effects of smoking status on major adverse cardiovascular events in the age subgroup analysis.
Figure 19
Figure 19
Forest plot of the effects of smoking status on major adverse cardiovascular events in the race subgroup analysis.
Figure 20
Figure 20
Forest plot of the effects of smoking status on major adverse cardiovascular events in patients taking different drugs.
Figure 21
Figure 21
Forest plot of combined hazard ratio (HR) on major adverse cardiovascular events (MACEs) in unadjusted and adjusted subgroup analysis.
Figure 22
Figure 22
Forest plot of combined hazard ratio (HR) on death events in unadjusted and adjusted subgroup analysis.
Figure 23
Figure 23
Forest plot of combined hazard ratio (HR) on myocardial infarction (MI) events in unadjusted and adjusted subgroup analysis.
Figure 24
Figure 24
Forest plot of combined hazard ratio (HR) on stroke events in unadjusted and adjusted subgroup analysis.
Figure 25
Figure 25
Funnel plot of the effects of smoking status on death events. OR indicates odds ratio.
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