术后使用氯吡格雷可改善非体外循环冠状动脉旁路移植术后的中期预后：一项前瞻性研究。

Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery: a prospective study.

作者信息

Gurbuz Ahmet Tayfun, Zia Ayhan A, Vuran Ali Can, Cui Haiyan, Aytac Aydin

机构信息

Department of Cardiothoracic Surgery and Cardiology, Anadolu Foundation Healthcare System, Gebze Kocaeli, Turkey.

出版信息

Eur J Cardiothorac Surg. 2006 Feb;29(2):190-5. doi: 10.1016/j.ejcts.2005.11.033.

DOI:10.1016/j.ejcts.2005.11.033

PMID:16388957

Abstract

OBJECTIVE

Clopidogrel decreases recurrent ischemic events and improves intracoronary stent patency. There are scarce data on the effect of short-term and long-term clopidogrel on symptom recurrence and adverse cardiac events following off-pump coronary artery bypass graft surgery (OPCAB).

METHODS

Postoperative antiplatelet medication use was prospectively evaluated in 591 OPCAB patients. Clopidogrel was administered for 30 days in 186 patients and 139 received long-term clopidogrel (mean 33.6+/-12.0 months) in addition to aspirin. Follow-up was 37.7+/-13.4 months. Symptom recurrence (angina and congestive heart failure), adverse cardiac events (myocardial infarction, coronary reintervention, and sudden cardiac death), and overall mortality were prospectively recorded. Multivariate Cox regression analysis was used to evaluate predictors of end points.

RESULTS

There was no difference with respect to preoperative risk factors between patient groups. In the multivariate analysis, postoperative clopidogrel independently decreased symptom recurrence (p<0.0001, OR 0.3 [0.15-0.99]; 95% CI) and adverse cardiac events (p<0.0001, OR 0.2 [0.10-0.45]; 95% CI). Clopidogrel receivers had significantly lower angina recurrence, myocardial infarction, coronary reintervention, and sudden cardiac death during follow-up. There was no difference in the incidence of end points between short-term (30 days) and long-term receivers of the drug. There were 17 bleeding complications (4 major and 13 minor) in 15 patients during the follow-up period. Of the 15 patients, 6 were on clopidogrel in addition to aspirin (1.8%) while the remaining 9 were on aspirin (3.3%) only at the time of bleeding (p=0.8).

CONCLUSIONS

Clopidogrel therapy was independently associated with decreased symptom recurrence and adverse cardiac events following OPCAB. Extending clopidogrel use beyond 30 days did not have a significant effect on defined end points.

摘要

目的

氯吡格雷可降低复发性缺血事件的发生率并改善冠状动脉内支架的通畅性。关于短期和长期使用氯吡格雷对非体外循环冠状动脉搭桥术（OPCAB）后症状复发及不良心脏事件影响的数据较少。

方法

对591例行OPCAB手术的患者术后抗血小板药物的使用情况进行前瞻性评估。186例患者服用氯吡格雷30天，139例患者除阿司匹林外还接受长期氯吡格雷治疗（平均33.6±12.0个月）。随访时间为37.7±13.4个月。前瞻性记录症状复发情况（心绞痛和充血性心力衰竭）、不良心脏事件（心肌梗死、冠状动脉再次干预和心源性猝死）及总体死亡率。采用多因素Cox回归分析评估终点事件的预测因素。

结果

患者组间术前危险因素无差异。在多因素分析中，术后使用氯吡格雷可独立降低症状复发率（p<0.0001，比值比0.3[0.15 - 0.99]；95%置信区间）和不良心脏事件发生率（p<0.0001，比值比0.2[0.10 - 0.45]；95%置信区间）。服用氯吡格雷的患者在随访期间心绞痛复发、心肌梗死、冠状动脉再次干预和心源性猝死的发生率显著更低。药物短期（30天）使用者和长期使用者的终点事件发生率无差异。随访期间15例患者出现17例出血并发症（4例严重出血和13例轻微出血）。在这15例患者中，6例在出血时除阿司匹林外还服用氯吡格雷（1.8%），其余9例仅服用阿司匹林（3.3%）（p = 0.8）。