Airoldi Flavio, Colombo Antonio, Morici Nuccia, Latib Azeem, Cosgrave John, Buellesfeld Lutz, Bonizzoni Erminio, Carlino Mauro, Gerckens Ulrich, Godino Cosmo, Melzi Gloria, Michev Iassen, Montorfano Matteo, Sangiorgi Giuseppe Massimo, Qasim Asif, Chieffo Alaide, Briguori Carlo, Grube Eberhard
Invasive Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
Circulation. 2007 Aug 14;116(7):745-54. doi: 10.1161/CIRCULATIONAHA.106.686048. Epub 2007 Jul 30.
The need for prolonged aspirin and thienopyridine therapy and the risk of stent thrombosis (ST) remain as drawbacks associated with drug-eluting stents.
A prospective observational cohort study was conducted between June 2002 and January 2004 on 3021 patients consecutively and successfully treated in 5389 lesions with drug-eluting stents. Detailed patient information was collected on antiplatelet therapy. We analyzed the incidence of ST throughout the 18-month follow-up period and its relationship with thienopyridine therapy. ST occurred in 58 patients (1.9%) at 18 months. Forty-two patients (1.4%) experienced the event within 6 months of stent implantation. Acute myocardial infarction (fatal or nonfatal) occurred in 46 patients (79%) and death in 23 patients (39%) with ST. The median interval from discontinuation of thienopyridine therapy to ST was 13.5 days (interquartile range 5.2 to 25.7 days) for the first 6 months and 90 days (interquartile range 30 to 365 days) between 6 and 18 months. On multivariable analysis, the strongest predictor for ST within 6 months of stenting was discontinuation of thienopyridine therapy (hazard ratio, 13.74; 95% CI, 4.04 to 46.68; P<0.001). Thienopyridine discontinuation after 6 months did not predict the occurrence of ST (hazard ratio, 0.94; 95% CI, 0.30 to 2.98; P=0.92).
Discontinuation of thienopyridine therapy was the major determinant of ST within the first 6 months, but insufficient information is available to determine whether there is benefit in continuing a thienopyridine beyond 6 months.
长期使用阿司匹林和噻吩并吡啶类药物治疗的必要性以及支架内血栓形成（ST）的风险仍是与药物洗脱支架相关的缺点。
2002年6月至2004年1月，对3021例连续成功接受5389处病变药物洗脱支架治疗的患者进行了一项前瞻性观察队列研究。收集了关于抗血小板治疗的详细患者信息。我们分析了整个18个月随访期内ST的发生率及其与噻吩并吡啶类药物治疗的关系。18个月时，58例患者（1.9%）发生ST。42例患者（1.4%）在支架植入后6个月内发生该事件。ST患者中，46例（79%）发生急性心肌梗死（致命或非致命），23例（39%）死亡。在最初6个月内，从停用噻吩并吡啶类药物治疗到发生ST的中位间隔时间为13.5天（四分位间距5.2至25.7天），6至18个月之间为90天（四分位间距30至365天）。多变量分析显示，支架植入后6个月内ST的最强预测因素是停用噻吩并吡啶类药物治疗（风险比，13.74；95%可信区间，4.04至46.68；P<0.001）。6个月后停用噻吩并吡啶类药物并不能预测ST的发生（风险比，0.94；95%可信区间，0.30至2.98；P=0.92）。
停用噻吩并吡啶类药物治疗是最初6个月内ST的主要决定因素，但尚无足够信息确定噻吩并吡啶类药物治疗超过6个月是否有益。
