冠状动脉支架置入术后患者对抗血小板治疗的依从性及其对预后的影响  

Compliance with dual antiplatelet therapy and its influence on clinical outcomes in patients undergoing percutaneous coronary stenting

作　　者：朱中玉[1] 陈岩[1] 高传玉[1] 牛振民[1] 黄克钧[1] 李牧蔚[1] 

机构地区：[1]河南省人民医院心内科,郑州450003

出　　处：《临床心血管病杂志》2009年第5期334-337,共4页Journal of Clinical Cardiology

摘　　要：目的:了解冠状动脉支架置入术后患者对抗血小板治疗的依从性及其对临床预后的影响。方法:对504例行冠状动脉内支架置入术的患者进行临床随访,调查抗血小板药物的应用情况及主要不良心脏事件(MACE)。结果:平均随访6～57(21.19±11.75)个月。术后498例(98.8%)的患者应用阿司匹林,503例(99.8%)的患者使用氯吡格雷,其应用时间为(9.56±3.95)个月。随访时64例患者擅自停用氯吡格雷,33例(6.55%)患者未服用阿司匹林;30例(5.95%)停止所有的抗血小板治疗。完全停止抗血小板治疗使非致死性心肌梗死(MI)(10.00%∶1.05%,OR9.77,95%CI2.32～40.10,P<0.01)及MACE(20.00%∶7.38%,OR3.25,95%CI1.26～8.41,P<0.05)的发生明显增加。通过logistic多元回归校正组间不匹配因素后,这种关系依然存在(非致死性MI,OR15.35,95%CI2.02～78.06,P<0.01;MACEOR3.21,95%CI1.19～8.65,P<0.05)。结论:冠状动脉支架置入术后患者对抗血小板治疗的依从性良好,完全停止抗血小板治疗会增加非致死性MI及MACE的危险。Objective： To investigate the compliance with dual antiplatelet therapy and its influence on clinical outcomes in patients undergoing percutaneous coronary stenting. Metbod ： The follow-up was performed in 504 patients undergoing coronary stenting in our department, including the duration and dosage of aspirin and clopidogrel and major adverse cardiac events（MACE）. Result： The average follow-up was 21.19 months. At discharge, 498 patients （98.8%） were on aspirin therapy, 503 patients （99.8%） took clopidogrel, the duration of clopidogrel was （9.56±3.95） months. At follow-up, most patients stopped clopidogrel according to physician＇s advice, 64 patients prematurely discontinued the clopidogrel therapy by themselves. There were 30 patients（5.95%） who completely discontinued all antiplatelet agents, which carried an increased risk of non-fatal MI（10 %vs 1.05 %,OR 9.77,95 % CI2.32 to 40.10 , P 〈0. 001） and MACE（20% vs 7.38%,OR 3.25, 95% CI 1.26 to 8.41,P= 0. 014）. After adjusting those confounding factors, withdrawal of antiplatelet therapy was markedly related to the increased risk of non-fatal MI（ adjusted OR 15.35,95% CI 2.02 to 78.06,P=0. 001） and MACE（ adjusted OR 3.21,95% CI 1.19 to 8.65 ,P=0. 021）. Conclusion.. In clinical practices, the compliance with antiplatelet therapy in patients undergoing coronary stent implantation remains suboptimal, but non-adherence to antiplatelet therapy is considered as important risk factors for non-fatal MI and MACE.

关 键 词：血管成形术 经腔 经皮冠状动脉 抗血小板治疗 依从性 预后 

分 类 号：R654.3[医药卫生—外科学]