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采用积极抗血小板治疗方案治疗急性冠脉综合征患者(源自全球急性冠脉事件注册研究)

Treating patients with acute coronary syndromes with aggressive antiplatelet therapy (from the Global Registry of Acute Coronary Events).

作者信息

Lim Michael J, Eagle Kim A, Gore Joel M, Anderson Frederick A, Dabbous Omar H, Mehta Rajendra H, Granger Christopher B, Fox Keith A A, Spencer Frederick A, Goldberg Robert J

机构信息

Saint Louis University, St. Louis, Missouri, USA.

出版信息

Am J Cardiol. 2005 Oct 1;96(7):917-21. doi: 10.1016/j.amjcard.2005.05.047.

Abstract

Few data exist on the use of aggressive combination therapy with thienopyridines and glycoprotein IIb/IIIa inhibitors in higher risk patients with an acute coronary syndrome (ACS). The aim of this study was to characterize the combined use of these agents and the associated hospital outcomes in patients with ACS enrolled in the multinational Global Registry of Acute Coronary Events. Data from 8,081 patients with non-ST-segment elevation myocardial infarction or unstable angina were analyzed. Of these patients, 5,070 (62.7%) received aspirin and a thienopyridine, and the remainder received aspirin, a thienopyridine, and a glycoprotein IIb/IIIa blocker. The presence of a non-ST-segment elevation myocardial infarction; a history of diabetes or coronary artery bypass surgery; performance of in-hospital catheterization, percutaneous coronary intervention, or coronary artery bypass grafting; and in-hospital use of heparin were independent predictors of the use of triple antiplatelet therapy with aspirin, thienopyridines, and glycoprotein IIb/IIIa blockers. Increased diastolic blood pressure and increased serum creatinine were associated with a failure to prescribe triple therapy. An increased risk of major bleeding during hospitalization was associated with the use of triple antiplatelet therapy (odds ratio 1.6, 95% confidence interval 1.2 to 2.2). Aggressive antiplatelet therapy was used in approximately 2 of every 5 patients presenting with an ACS. Triple therapy was associated with the performance of catheterization and/or percutaneous coronary intervention, as well as high-risk patient features. Although no differences in hospital death rates were evident in patients receiving triple therapy, this population was at significantly increased risk of major bleeding episodes during hospitalization.

摘要

关于在急性冠状动脉综合征(ACS)高危患者中联合使用噻吩吡啶类药物和糖蛋白IIb/IIIa抑制剂进行强化治疗的数据较少。本研究的目的是描述这些药物在多国急性冠状动脉事件全球注册研究中ACS患者中的联合使用情况及相关的住院结局。分析了8081例非ST段抬高型心肌梗死或不稳定型心绞痛患者的数据。在这些患者中,5070例(62.7%)接受了阿司匹林和噻吩吡啶类药物,其余患者接受了阿司匹林、噻吩吡啶类药物和糖蛋白IIb/IIIa阻滞剂。非ST段抬高型心肌梗死的存在;糖尿病或冠状动脉搭桥手术史;住院期间进行导管插入术、经皮冠状动脉介入治疗或冠状动脉搭桥术;以及住院期间使用肝素是使用阿司匹林、噻吩吡啶类药物和糖蛋白IIb/IIIa阻滞剂进行三联抗血小板治疗的独立预测因素。舒张压升高和血清肌酐升高与未开具三联疗法有关。住院期间大出血风险增加与使用三联抗血小板治疗相关(比值比1.6,95%置信区间1.2至2.2)。每5例ACS患者中约有2例使用了强化抗血小板治疗。三联疗法与导管插入术和/或经皮冠状动脉介入治疗的实施以及高危患者特征相关。尽管接受三联疗法的患者住院死亡率无明显差异,但该人群住院期间大出血事件的风险显著增加。

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