Berger Jeffrey S, Stebbins Amanda, Granger Christopher B, Ohman Eric M, Armstrong Paul W, Van de Werf Frans, White Harvey D, Simes R John, Harrington Robert A, Califf Robert M, Peterson Eric D
Duke Clinical Research Institute, Durham, NC, USA.
Circulation. 2008 Jan 15;117(2):192-9. doi: 10.1161/CIRCULATIONAHA.107.729558. Epub 2007 Dec 17.
Although treatment with immediate aspirin reduces morbidity and mortality in ST-elevation myocardial infarction, the optimal dose is unclear. We therefore compared the acute mortality and bleeding risks associated with the initial use of 162 versus 325 mg aspirin in fibrinolytic-treated ST-elevation myocardial infarction patients.
Using combined data from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO I) and Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO III) trials (n=48 422 ST-elevation myocardial infarction patients), we compared the association between initial aspirin dose of 162 versus 325 mg and 24-hour and 7-day mortality, as well as rates of in-hospital moderate/severe bleeding. Results were adjusted for previously identified mortality and bleeding risk factors. Overall, 24.4% of patients (n=11 828) received an initial aspirin dose of 325 mg, and 75.6% (n=36 594) received 162 mg. The 24-hour mortality rates were 2.9% versus 2.8% (P=0.894) for those receiving an initial aspirin dose of 325 versus 162 mg. Mortality rates at 7 and 30 days were 5.2% versus 4.9% (P=0.118) and 7.1% versus 6.5% (P=0.017) among patients receiving the 325 versus 162 mg aspirin. After adjustment, aspirin dose was not associated with 24-hour (odds ratio [OR], 1.01; 95% CI, 0.82 to 1.25), 7-day (OR, 1.00; 95% CI, 0.87 to 1.17), or 30-day (OR, 0.99; 95% CI, 0.87 to 1.12) mortality rates. No significant difference was noted for myocardial infarction or the composite of death or myocardial infarction between groups. In-hospital moderate/severe bleeding occurred in 9.3% of those treated with 325 mg versus 12.2% among those receiving 162 mg (P<0.001). After adjustment, 325 mg was associated with a significant increase in moderate/severe bleeding (OR, 1.14; 95% CI, 1.05 to 1.24; P=0.003).
These data suggest that an initial dose of 162 mg aspirin may be as effective as and perhaps safer than 325 mg for the acute treatment of ST-elevation myocardial infarction.
尽管在ST段抬高型心肌梗死中立即使用阿司匹林治疗可降低发病率和死亡率，但最佳剂量尚不清楚。因此，我们比较了在接受纤溶治疗的ST段抬高型心肌梗死患者中，初始使用162毫克与325毫克阿司匹林的急性死亡率和出血风险。
利用来自冠状动脉闭塞的链激酶和组织纤溶酶原激活剂全球应用研究（GUSTO I）和冠状动脉闭塞开通策略全球应用研究（GUSTO III）试验（n = 48422例ST段抬高型心肌梗死患者）的合并数据，我们比较了初始阿司匹林剂量为162毫克与325毫克与24小时和7天死亡率以及院内中度/重度出血发生率之间的关联。对先前确定的死亡率和出血风险因素进行了结果调整。总体而言，24.4%的患者（n = 11828）接受了325毫克的初始阿司匹林剂量，75.6%（n = 36594）接受了162毫克。接受325毫克初始阿司匹林剂量的患者24小时死亡率为2.9%，而接受162毫克的患者为2.8%（P = 0.894）。接受325毫克与162毫克阿司匹林的患者7天和30天死亡率分别为5.2%对4.9%（P = 0.118）和7.1%对6.5%（P = 0.017）。调整后，阿司匹林剂量与24小时（比值比[OR]，1.01；95%可信区间，0.82至1.25）、7天（OR，1.00；95%可信区间，0.87至1.17）或30天（OR，0.99；95%可信区间，0.87至1.12）死亡率无关。两组之间在心肌梗死或死亡或心肌梗死复合终点方面未观察到显著差异。接受325毫克治疗的患者院内中度/重度出血发生率为9.3%，而接受162毫克的患者为12.2%（P < 0.001）。调整后，325毫克与中度/重度出血显著增加相关（OR，1.14；95%可信区间，1.05至1.24；P = 0.003）。
这些数据表明，对于ST段抬高型心肌梗死的急性治疗，162毫克的初始阿司匹林剂量可能与325毫克一样有效，甚至可能更安全。
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