Foussas S, Alexopoulos D, Stefanadis C, Olympios C, Voudris V, Hatzimiltiadis S, Sionis D, Vavouranakis E, Vrahatis A, Fakiolas C, Pissimisis E, Stefanidis A, Zairis M, Pavlides G, Vitakis S, Louridas G, Cokkinos D, Toutouzas P
Dept. of Cardiology, Tzanio State Hospital, Piraeus, Greece.
Angiology. 2000 Apr;51(4):289-94. doi: 10.1177/000331970005100403.
Stent prosthesis is a high efficacious method with low complication rates. However, the ideal adjunctive therapy following stent implantation remains controversial. The authors compared the effectiveness and complication rates of aspirin-ticlopidine antiplatelet therapy vs. anticoagulant therapy with acenocoumarol within 30 days following stent prosthesis. They prospectively studied 404 patients following stent prosthesis while randomly receiving anticoagulant (Group A: 201 patients) vs. antiplatelet treatment (Group B: 203 patients). Groups A and B were similar in demographic data (age, gender), stent location, clinical presentation, indication of stenting, and type of implanted stent. Chi-square test, t test, and Wilcoxon test for two samples were used for statistical analysis of the results. Stent implantation was attempted in 434 cases. This was successful in 70/85 (82%) of the bailout, 122/135 (90%) of the suboptimal, and 212/214 (99%) of the elective cases. In 201 patients anticoagulant treatment with acenocoumarol was administered for 4 weeks (group A), while 203 received antiplatelet treatment with ticlopidine (group B). The need for reintervention was less and total cardiac events were fewer in group B than in group A: three (1.5%) and nine (4.4%) vs 18 (9%) and 29 (14.4%), p<0.0008 and p<0.006 respectively. Hemorrhagic complications and total noncardiac events were fewer in group B than in group A: six (3%) and six (3%) vs. 18 (9%) and 19 (9.5%), p<0.01 and p<0.007 respectively. The length of hospital stay was shorter in group B than in A, p<0.0001. In conclusion, in this study of intracoronary stenting the authors had a high success rate in 434 attempted cases. Antiplatelet therapy was accompanied by fewer cardiac and noncardiac 1 month events when compared with anticoagulant therapy, supporting its role as the adjunctive treatment of choice post-stenting for the time being.
支架假体是一种并发症发生率低的高效方法。然而，支架植入后的理想辅助治疗仍存在争议。作者比较了支架假体植入后30天内阿司匹林-噻氯匹定抗血小板治疗与醋硝香豆素抗凝治疗的有效性和并发症发生率。他们前瞻性地研究了404例接受支架假体植入的患者，这些患者随机接受抗凝治疗（A组：201例患者）或抗血小板治疗（B组：203例患者）。A组和B组在人口统计学数据（年龄、性别）、支架位置、临床表现、支架置入指征和植入支架类型方面相似。采用卡方检验、t检验和两样本Wilcoxon检验对结果进行统计分析。共尝试进行434例支架植入。其中，补救性支架植入成功率为70/85（82%），次优支架植入成功率为122/135（90%），择期支架植入成功率为212/214（99%）。201例患者接受醋硝香豆素抗凝治疗4周（A组），203例患者接受噻氯匹定抗血小板治疗（B组）。B组再次干预的需求和总的心脏事件比A组少：分别为3例（1.5%）和9例（4.4%），而A组为18例（9%）和29例（14.4%），p<0.0008和p<0.006。B组的出血并发症和总的非心脏事件比A组少：分别为6例（3%）和6例（3%），而A组为18例（9%）和19例（9.5%），p<0.01和p<0.007。B组的住院时间比A组短，p<0.0001。总之，在这项冠状动脉内支架植入研究中，作者在434例尝试病例中成功率很高。与抗凝治疗相比，抗血小板治疗在1个月时的心脏和非心脏事件较少，这支持了其作为目前支架植入后首选辅助治疗的作用。
