冠心病患者DES置入后双联抗血小板服用时间与预后的研究  

The follow-up study of dual antiplatelet therapy(DAPT) duration and the prognosis of coronary heart diseases patients after drug-eluting stent(DES) implantation

作　　者：王国位 甘继宏[2] 钟文波[2] 马丽群 路军 任可 秦永文[1] Wang Guowei;Gan Jihong;Zhong Wenbo;Ma Liqun;Lu Jun;Ren Ke;Qin Yongwen(Department of Cardiology,Changhai Hospital,The Second Military Medical University,Shanghai 200433,China)

机构地区：[1]第二军医大学附属长海医院心血管内科,上海200433 [2]新疆军区总医院心血管内科,乌鲁木齐830000

出　　处：《中国循证心血管医学杂志》2018年第3期283-287,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家自然科学基金(81470407)

摘　　要：目的探索冠心病患者药物洗脱支架(DES)置入后阿司匹林联合P2Y12抑制剂双联抗血小板治疗(DAPT)时程对主要不良心脏事件(MACE)及出血的影响。方法回顾性纳入2008年1月~2009年5月于新疆军区总医院心血管内科成功置入DES,并于2014年6~9月通过电话、再住院及门诊方式随访成功的250例患者为研究对象。术后DAPT方案为阿司匹林联合硫酸氢氯吡格雷,停用硫酸氢氯吡格雷后继续使用阿司匹林。根据DAPT时间分为三组,A组<12月(n=44例),B组=12月(n=119例),C组>12月(n=87例)。分析组间临床资料、冠状动脉病变特点、手术资料有无差异。平均随访时间(59.79±5.25)月。主要终点MACE:包括再发心绞痛、再次心梗、靶病变/靶血管的再次血运重建(TLR/TVR)及全因死亡;次要终点:消化道出血。比较组间主次要终点及生存曲线有无统计学意义。临床基线资料有统计学意义者与DAPT时间行相关分析。结果三组基线除了年龄、支架平均直径(P<0.05)外其他均不具统计学意义(P>0.05)。相关分析年龄、平均支架直径与DAPT时间无相关性(P>0.05);随访期内:三组间主要终点及总MACE差异无统计学意义(P>0.05),次要终点差异未达统计学意义(P>0.05),但C组出血发生率19.5%有高于A组(4.5%)和B组(4.2%)的趋势,主要终点生存曲线分析无统计学意义(Log-Rankχ2=2.004,P=0.367)。结论单中心冠心病DES置入后,DAPT不同时程组疗效相似,延长DAPT时程增加了出血风险。DES置入后DAPT治疗宜个体化,以降低出血风险。Objective Aspirin combined with a P2Y12 inhibitor,namely as dual antiplatelet therapy(DAPT),was being regarding as standard regimens after drug-eluting stent implantation in coronary heart diseases patients.It is important in reducing hemorrhagic complications and decreasing costs to explore rational DAPT duration.To investigate the effects of different DAPT duration on major adverse cardiac events(MACE)and hemorrhage events after drug-eluting stent implantation in coronary heart diseases patients.Methods This study was a retrospective cases analysis,A total of 250 patients who had undergone successfully DES implantation from Jan 2008 to Mar 2009 and followed-up successfully from Jun to Sep 2014 by telephone,outpatient and rehospitalization were enrolled and divided into 3 groups according to the DAPT duration:A group:<12 months(n=44 patients);B group:=12 months(n=119 patients);C group:>12 months(n=87 patients).All patients received DAPT(aspirin and clopidogrel).Aspirin was required to administrate continuely after clopidogrel interruption.The average follow-up time was 59.79±5.25 months.The primary endpoint was MACE including re-angina,re-myocardial infarction(re-MI)and target vessel/lesion revascularization(TVR/TLR)and all-cause death;Secondary endpoint was the hemorrhagic events.Clinical data,coronary lesion characteristics,peri-operation information were compared,the differences of primary and secondary endpoint events,survival rate among groups were analyzed.The correlation analysis between significant baseline data and DAPT duration was conducted.Results There was no significant difference of the Clinical data,coronary lesion characteristics,peri-operation information among three groups(P>0.05),except ages and the mean stent diameter(P<0.05).There was no correlation between ages,the mean stent diameter and DAPT duration(P>0.05).There was no significant difference of primary and secondary endpoint events,survival curves(Log-Rank test)among three groups(P>0.05).However,the incidence of hemorrhage in group C

关 键 词：冠心病 药物洗脱支架 双联抗血小板 随访研究 

分 类 号：R541.4[医药卫生—心血管疾病]