已接受氯吡格雷长期治疗的急性冠状动脉综合征患者的预后。

Prognosis of patients suffering an acute coronary syndrome while already under chronic clopidogrel therapy.

作者信息

Bonello Laurent, De Labriolle Axel, Lemesle Gilles, Steinberg Daniel H, Roy Probal, Torguson Rebecca, Suddath William O, Satler Lowell F, Kent Kenneth M, Pichard Augusto D, Waksman Ron

机构信息

Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.

出版信息

Catheter Cardiovasc Interv. 2009 Jun 1;73(7):866-70. doi: 10.1002/ccd.21935.

DOI:10.1002/ccd.21935

PMID:19198009

Abstract

OBJECTIVE

To assess the prognosis of patients presenting with an acute coronary syndrome (ACS) despite chronic clopidogrel therapy (CCT).

BACKGROUND

CCT has been shown to be beneficial in decreasing the frequency of major adverse cardiovascular events (MACE) in patients after an ACS or drug-eluting stent (DES) implantation. Some patients, however, still suffer thrombotic events while on CCT. The outcome of this particular subgroup of patients is unknown.

METHODS

A cohort of 1,281 patients undergoing percutaneous coronary intervention (PCI) for an ACS was studied. They were divided according to their treatment prior to the ACS. The CCT group was composed of all patients who had been taking clopidogrel for >or=30 days before the onset of the ACS (n = 175) and the no CCT group of all patients not on clopidogrel before the ACS (n = 1,106). Rates of cardiovascular death and myocardial infarction at 6 months' follow-up were compared.

RESULTS

Patients in the CCT group were older (66 +/- 11 vs. 63 +/- 13; P< 0.001), and more often diabetic (46.8 vs. 31.9%; P < 0.01). In-hospital outcomes were similar, including the rate of death and myocardial infarction (no CCT vs. CCT group: 4.2 vs. 2.3%; P = 0.2). At 6 months, patients already taking clopidogrel before the ACS had a higher rate of MACE than patients who were not (18.3 vs. 11.8%; P = 0.02). In multivariate analysis, CCT before the ACS was associated with a hazard ratio of 1.7 for MACE.

CONCLUSION

This study suggests that patients suffering an ACS while under on CCT have a poor long-term prognosis, which could be linked to clopidogrel low-response.

摘要

目的

评估尽管接受氯吡格雷长期治疗（CCT）但仍出现急性冠状动脉综合征（ACS）的患者的预后情况。

背景

CCT已被证明有助于降低ACS患者或药物洗脱支架（DES）植入术后患者发生主要不良心血管事件（MACE）的频率。然而，一些患者在接受CCT治疗时仍会发生血栓事件。这一特定亚组患者的预后情况尚不清楚。

方法

对1281例因ACS接受经皮冠状动脉介入治疗（PCI）的患者进行了研究。根据他们在ACS之前的治疗情况进行分组。CCT组由所有在ACS发作前服用氯吡格雷≥30天的患者组成（n = 175），非CCT组由所有在ACS之前未服用氯吡格雷的患者组成（n = 1106）。比较了6个月随访时的心血管死亡和心肌梗死发生率。

结果

CCT组患者年龄更大（66±11岁对63±13岁；P<0.001），糖尿病患者更多（46.8%对31.9%；P<0.01）。住院结局相似，包括死亡率和心肌梗死发生率（非CCT组对CCT组：4.2%对2.3%；P = 0.2）。在6个月时，ACS发作前已服用氯吡格雷的患者发生MACE的发生率高于未服用氯吡格雷的患者（18.3%对11.8%；P = 0.02）。在多变量分析中，ACS发作前的CCT与MACE的风险比为1.7相关。