So Derek, Cook E Francis, Le May Michel, Glover Chris, Williams William, Ha Andrew, Davies Richard, Froeschl Michael, Marquis Jean-Fran Cois, O'Brien Edward, Labinaz Marino
University of Ottawa Heart Institute, Cardiology, Ottawa, Ontario, Canada.
J Invasive Cardiol. 2009 Mar;21(3):121-7.
Dual antiplatelet therapy, with aspirin and a thienopyridine, is the accepted treatment after percutaneous coronary intervention (PCI). No clear evidence exists regarding the ideal dosage of aspirin. Recent guidelines recommend higher-dose aspirin because of the possible decrease in stent thrombosis. The purpose of this study was to test the hypothesis that high-dose aspirin of 325 mg decreases death and myocardial infarction (MI) compared to a lower dose of 81 mg in patients undergoing PCI.
An observational cohort study of 1,840 consecutive patients who underwent PCI was conducted. Patients who did not survive to discharge were excluded. The primary endpoint was a composite of all-cause mortality and MI at 1 year.
Nine-hundred and thirty patients (50.5%) were discharged on 325 mg of aspirin and 910 (49.5%) were discharged of 81 mg. The risk of all-cause mortality or MI was not significantly different between patients: low-dose 5.49% (50/910) vs. high-dose 4.19% (39/930); adjusted odds ratio [OR], 1.16; 95% confidence interval [CI], 0.73-1.85). In a multivariable analysis, the Charlson comorbidity score (OR, 1.37; 95% CI, 1.18-1.58) and urgent PCI (OR, 1.75; 95% CI, 1.03-3.00) were associated with increased death or MI. Among patients with drug-eluting stents, the use of low-dose aspirin did not predispose them to death or MI (adjusted OR, 1.12, 95% CI, 0.53-2.34).
In this large contemporary analysis of PCI patients, no differences in death or MI were observed at 1 year between patients discharged on low-dose aspirin 81 mg compared to patients on a higher dose.
阿司匹林和噻吩并吡啶联合应用的双重抗血小板治疗是经皮冠状动脉介入治疗（PCI）后公认的治疗方法。关于阿司匹林的理想剂量尚无明确证据。近期指南推荐使用高剂量阿司匹林，因为可能会降低支架内血栓形成的风险。本研究的目的是检验以下假设：在接受PCI的患者中，与81mg的低剂量相比，325mg的高剂量阿司匹林可降低死亡和心肌梗死（MI）的发生率。
对1840例连续接受PCI的患者进行了一项观察性队列研究。未存活至出院的患者被排除。主要终点是1年时全因死亡率和MI的复合终点。
930例患者（50.5%）出院时服用325mg阿司匹林，910例患者（49.5%）出院时服用81mg阿司匹林。患者之间全因死亡率或MI的风险无显著差异：低剂量组为5.49%（50/910），高剂量组为4.19%（39/930）；调整后的优势比[OR]为1.16；95%置信区间[CI]为0.73 - 1.85）。在多变量分析中，Charlson合并症评分（OR，1.37；95%CI，1.18 - 1.58）和急诊PCI（OR，1.75；95%CI，1.03 - 3.00）与死亡或MI增加相关。在使用药物洗脱支架的患者中，使用低剂量阿司匹林并未使他们更容易发生死亡或MI（调整后的OR，1.12，95%CI，0.53 - 2.34）。
在这项对PCI患者的大型当代分析中，出院时服用81mg低剂量阿司匹林的患者与服用高剂量阿司匹林的患者相比，1年时在死亡或MI方面未观察到差异。
