血小板功能检测指导的降阶治疗对急性冠状动脉综合征患者介入术后的影响  

The effectiveness of de-escalation guided by platelet function test on the prognosis of acute coronary syndrome patients after percutaneous coronary intervention

作　　者：赵志刚[1] 孙雪 李雅超 雷梦杰 杨彦立[1] 安蕾 周海立[1] 王敬尧 李彩榕 薛增明[1] ZHAO Zhigang;SUN Xue;LI Yachao;LEI Mengjie;YANG Yanli;AN Lei;ZHOU Haili;WANG Jingyao;LI Cairong;XUE Zengming(Department of Cardiology,Langfang People's Hospital,Hebei Medical University,Langfang Core Laboratory of Precision Treatment of CAD,Langfang 065000,China)

机构地区：[1]廊坊市人民医院、河北医科大学廊坊市冠心病精准治疗重点实验室心内科,065000

出　　处：《心肺血管病杂志》2023年第11期1108-1113,1119,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：廊坊科技研发计划自筹基金项目(2022013038);河北省医学科学研究计划指导性课题(20232053)。

摘　　要：目的:探究急性冠状动脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后3个月时,血小板功能检测(platelet function test,PFT)指导的降阶治疗与常规经验性降阶治疗相比,是否可改善预后。方法:收集2020年6月至2021年12月期间,行PCI的ACS患者302例,术后均给予强化抗血小板治疗(阿司匹林100mg+替格瑞洛90mg),依据术后3个月时是否行血小板功能检测分为PFT指导组156例(依据血小板功能检测结果,若二磷酸腺苷最大聚集率≤50%即降阶),常规治疗组146例(临床医师依据诊疗经验决定是否降阶),降阶治疗方案为(阿司匹林100mg+氯吡格雷75mg/替格瑞洛60mg),平均随访时间为(11.9±0.9)个月。主要终点为随访期间发生的主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular events,MACCEs),包括心源性死亡、心肌梗死、缺血驱动的再次血运重建、卒中的复合终点,安全性终点为出血事件,包括大出血和小出血。结果:两组患者MACCEs、出血事件发生率差异无统计学意义,Cox回归分析显示血小板功能检测指导降阶对PCI术后ACS患者的MACCEs和出血事件无显著影响(P>0.05)。结论:对于PCI术后ACS患者,和常规经验性降阶治疗相比较,术后3个月时血小板功能检测指导的降阶治疗未能改善缺血和出血事件的发生。Objective:To investigate whether the de-escalation guided by platelet function test at 3 months after percutaneous coronary intervention(PCI)can improve the prognosis of patients with acute coronary syndrome(ACS).Methods:A total of 302 patients with ACS undergoing PCI from June 2020 to December 2021 were included.All patients were given intensive antiplatelet therapy(ticagrelor 90mg+aspirin 100 mg)after PCI.156 patients were divided into the PFT guiding group(Whether or not to use the de-escalation is according to the maximum aggregation rate of ADP is≤50%)and 146 patients into the routing group(Whether or not to use the de-escalation is according to the clinician experience in diagnosis and treatment)according to whether platelet function test was detected at 3 months after PCI.The de-escalation is clopidogrel 75mg/ticagrelor 60mg and aspirin 100 mg.The mean follow-up time was(11.9±0.9)months.The primary end point was major adverse cardiovascular and cerebrovascular events(MACCEs)found during follow-up that included the composite endpoints of cardiac death,myocardial infarction,ischemia driven revascularization,and stroke.The safety end point was bleeding events,including major bleeding and minor bleeding.Results:There was no statistical difference in the incidence of MACCEs and bleeding events between the two groups.Cox regression results showed that there was no significant effect on MACCEs and bleeding events in ACS patients undergoing PCI whether de-escalation guided by platelet function test(P>0.05).Conclusions:For patients with ACS undergoing PCI,the de-escalation guided by platelet function test at 3 months after PCI failed to significantly improve the occurrence of ischemic and bleeding events compared to experience de-escalation.

关 键 词：急性冠状动脉综合征 经皮冠状动脉介入治疗 降阶 血小板功能检测 主要不良心脑血管事件 

分 类 号：R54[医药卫生—心血管疾病]