Blanchard D, Demicheli T, Danchin N
Clinique Saint-Gatien, 8, place de la-Cathédrale, 37000 Tours, France.
Ann Cardiol Angeiol (Paris). 2003 Jun;52(3):169-72. doi: 10.1016/s0003-3928(03)00068-4.
Ticlopidine or clopidogrel combined with aspirin decrease major cardiac events (Mace) after PTCA with stent implantation. It has not be proven yet that pretreatment by T or C was superior to conventional post-treatment, especially in unstable patients. The aim of the present study was to determine the influence of thienopyridine pretreatment on the risk of Mace (death, Q wave myocardial infarction, need for repeat PTCA or surgery, angina recurrence, stent thrombosis) during the hospitalization period in a population prospectively included in 2 multicentre registries of patients undergoing placement of a S670 or S7 stent (Medtronic) implanted in native coronary arteries (> or = 3.0 mm). Among the 2929 patients included into the registries, 1205 had unstable angina (41%). 50.2% of the patients were pretreated by T or C (T = 15.7%, C = 34.5%); 85.5% received aspirin before the procedure; definition of pretreatment was the administration of drug at least 6 hours before stent implantation. GPIIb-IIIa antagonists were administered in only 13.9% of patients. Mace were observed in 2% of the patients. Factors correlated with Mace by univariate and multivariate analyses were: age > 73 years (RR: 2.37; 95% CI: 1.05-5.36, P < 0.037), previous myocardial infarction (RR: 2.56; 95% CI: 1.08-6.11, P < 0.034), pretreatment by T or C (RR: 0.389; 95% CI: 0.16-0.95, P < 0.038). In patients who did not receive GPIIb-IIIa antagonists, age > 73, and pretreatment by T or C were the only independent predictors of Mace.
噻氯匹定或氯吡格雷联合阿司匹林可降低经皮冠状动脉腔内血管成形术（PTCA）并植入支架后的主要心脏事件（Mace）发生率。目前尚未证实噻氯匹定（T）或氯吡格雷（C）预处理优于传统的术后治疗，尤其是在不稳定患者中。本研究的目的是确定噻吩并吡啶预处理对前瞻性纳入2个多中心登记处的患者群体住院期间发生Mace（死亡、Q波心肌梗死、需要再次进行PTCA或手术、心绞痛复发、支架血栓形成）风险的影响，这些患者接受了植入天然冠状动脉（≥3.0 mm）的S670或S7支架（美敦力公司）。在登记的2929例患者中，1205例患有不稳定型心绞痛（41%）。50.2%的患者接受了T或C预处理（T = 15.7%，C = 34.5%）；85.5%的患者在手术前服用了阿司匹林；预处理的定义是在支架植入前至少6小时给药。仅13.9%的患者使用了糖蛋白IIb/IIIa拮抗剂。2%的患者发生了Mace。单因素和多因素分析中与Mace相关的因素为：年龄>73岁（相对危险度：2.37；95%可信区间：1.05 - 5.36，P < 0.037）、既往心肌梗死（相对危险度：2.56；95%可信区间：1.08 - 6.11，P < 0.034）、T或C预处理（相对危险度：0.389；95%可信区间：0.16 - 0.95，P < 0.038）。在未接受糖蛋白IIb/IIIa拮抗剂的患者中，年龄>73岁和T或C预处理是Mace的唯一独立预测因素。
