药物洗脱支架置入术后延长双联抗血小板疗程对老年冠心病合并糖尿病患者远期预后的影响  

Impact of prolonging dual antiplatelet therapy on long-term prognosis of elderly patients with coronary heart disease complicated with diabetes mellitus undergoing drug-eluting stent implantation

作　　者：许晶晶[1] 朱佩[1] 宋莹[1] 袁德山 贾斯达 赵雪燕[1] 姚懿[1] 姜琳[1] 徐娜[1] 李建新[1] 张茵[1] 宋雷[1] 高立建[1] 陈纪林[1] 乔树宾[1] 杨跃进[1] 徐波[1] 高润霖[1] 袁晋青[1] Xu Jingjing;Zhu Pei;Song Ying;Yuan Deshan;Jia Sida;Zhao Xueyan;Yao Yi;Jiang Lin;Xu Na;Li Jianxin;Zhang Yin;Song Lei;Gao Lijian;Chen Jilin;Qiao Shubin;Yang Yuejin;Xu Bo;Gao Runlin;Yuan Jinqing(Department of Cardiology,Fuwai Hospital and Cardiovascular Institute,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院,国家心血管病中心阜外医院心内科,北京100037

出　　处：《中华心血管病杂志》2022年第5期450-457,共8页Chinese Journal of Cardiology

基　　金：国家重点研发计划项目(2016YFC1301300,2016YFC13013001);中国医疗保健国际交流促进会研究者申办试验(CN174125,DIREGL08735-DAPT);中国医学科学院临床与转化医学研究基金项目(CIFMS:2020-I2M-C&T-B-049)。

摘　　要：目的探讨老年冠心病合并糖尿病患者置入药物洗脱支架(DES)后,延长双联抗血小板(DAPT)疗程与标准疗程相比对远期预后的影响。方法本研究为前瞻性队列研究,连续纳入2013年1至12月在阜外医院行经皮冠状动脉介入治疗(PCI)的冠心病患者,且符合糖尿病诊断标准、年龄≥65岁、行DES置入且术后1年内未发生不良事件。根据DAPT疗程将患者分为3组:标准DAPT疗程组(11个月≤DAPT疗程≤13个月)、延长DAPT疗程组(包括13个月<DAPT疗程≤24个月组和DAPT疗程>24个月组)。分别于出院1、6个月,1、2和5年对患者进行随访,记录主要不良心脑血管事件(MACCE)和出血学术研究联合会(BARC)定义的2~5型出血发生情况。其中,MACCE包括全因死亡、心肌梗死、靶血管血运重建或卒中。比较3组患者各临床事件的发生情况,并采用多因素Cox回归模型分析不同DAPT疗程对患者5年远期预后的影响。结果共纳入1562例患者,年龄(70.8±4.5)岁,女性398例(25.5%)。其中标准DAPT疗程组467例,13个月<DAPT疗程≤24个月组684例,DAPT疗程>24个月组411例。采用标准DAPT疗程和延长DAPT疗程者分别占比29.9%(467/1562)和70.1%(1095/1562)。5年随访结果显示,13个月<DAPT疗程≤24个月组[4.8%(33/684)比8.6%(40/467),P=0.011]及DAPT疗程>24个月组患者的全因死亡发生率[4.1%(17/411)比8.6%(40/467),P=0.008]均低于标准DAPT疗程组。13个月<DAPT疗程≤24个月组患者的心肌梗死发生率低于标准DAPT疗程组[1.9%(13/684)比5.1%(24/467),P=0.002]。13个月<DAPT≤24个月组的MACCE发生率最低[标准DAPT疗程组、13个月<DAPT疗程≤24个月组及DAPT疗程>24个月组分别为19.3%(90/467)、12.3%(84/684)、20.2%(83/411),P<0.001]。3组间卒中和出血事件的发生率差异无统计学意义(P均>0.05)。多因素Cox回归分析结果显示,以标准DAPT疗程为对照,延长DAPT疗程至<13~24个月与MACCE(HR=0.601,95%CI 0.446~0.811,P=0.001)、全因死亡(HR=0.568,95%CI 0.357~Objective To explore and compare the effect of standard or prolonged dual antiplatelet therapy(DAPT)on the long-term prognosis of elderly patients with coronary heart disease complicated with diabetes mellitus after drug-eluting stent(DES)implantation.Methods Consecutive patients with diabetes mellitus,≥65 years old,underwent DES implantation,and had no adverse events within 1 year after operation underwent percutaneous coronary intervention(PCI)from January to December 2013 in Fuwai Hospital were enrolled in this prospective cohort study.These patients were divided into three groups according to DAPT duration:standard DAPT duration group(11≤DAPT duration≤13 months)and prolonged DAPT duration group(13<DAPT duration≤24 months;DAPT duration>24 months).All the patients were followed up at 1,6 months,1,2 and 5 years in order to collect the incidence of major adverse cardiovascular and cerebrovascular events(MACCE),and type 2 to 5 bleeding events defined by the Federation of Bleeding Academic Research(BARC).MACCE were consisted of all cause death,myocardial infarction,target vessel revascularization or stroke.The incidence of clinical adverse events were compared among 3 different DAPT duration groups,and Cox regression model were used to analyze the effect of different DAPT duration on 5-year long-term prognosis.Results A total of 1562 patients were enrolled,aged(70.8±4.5)years,with 398 female(25.5%).There were 467 cases in standard DAPT duration group,684 cases in 13<DAPT duration≤24 months group and 411 cases in DAPT duration>24 months group.The patients in standard DAPT duration group and the prolonged DAPT duration groups accounted for 29.9%(467/1562)and 70.1%(1095/1562),respectively.The 5-year follow-up results showed that the incidence of all-cause death in 13<DAPT duration≤24 months group(4.8%(33/684)vs.8.6%(40/467),P=0.011)and DAPT duration>24 month group(4.1%(17/411)vs.8.6%(40/467),P=0.008)were significantly lower than in standard DAPT group.The incidence of myocardial infarction in 13<DAPT dura

关 键 词：冠状动脉疾病 双联抗血小板 糖尿病 老年 经皮冠状动脉介入术 预后 

分 类 号：R541.4[医药卫生—心血管疾病] R587.1[医药卫生—内科学]