Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Paseo Vall d'Hebron 119-129, Barcelona 08035, Spain.
Circulation. 2010 Sep 7;122(10):1017-25. doi: 10.1161/CIRCULATIONAHA.110.938290. Epub 2010 Aug 23.
Predictors of antiplatelet therapy discontinuation (ATD) during the first year after drug-eluting stent implantation are poorly known.
This was a prospective study with 3-, 6-, 9-, and 12-month follow-up of patients receiving at least 1 drug-eluting stent between January and April 2008 in 29 hospitals. Individual- and hospital-level predictors of ATD were assessed by hierarchical-multinomial regression analysis. ATD could be assessed in 1622 candidates for follow-up (82.5%). A total of 234 patients (14.4%) interrupted at least 1 antiplatelet therapy drug, predominantly clopidogrel (n=182, 11.8%). Bleeding events or invasive procedures led to ATD in 109 patients. This was predicted by renal impairment (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.48 to 5.34), prior major hemorrhage (OR 3.77, 95% CI 1.41 to 10.03), and peripheral arterial disease (OR 1.78, 95% CI 1.01 to 3.15). Medical decisions led to ATD in 70 patients; this was predicted by long-term use of anticoagulant therapy (OR 3.88, 95% CI 1.26 to 11.98), undergoing the procedure in a private hospital (OR 13.3, 95% CI 1.69 to 105), and not receiving instructions about medication (OR 2.8, 95% CI 1.23 to 6.36). Thirty-nine patients interrupted ATD on their own initiative, mainly immigrants (OR 3.78, 95% CI 1.2 to 11.98) and consumers of psychotropic drugs (OR 2.58, 95% CI 1.3 to 5.12).
ATD during the first year after drug-eluting stent implantation is based mainly on patient decision or a medical decision not associated with major bleeding events or major surgical procedures. Individual- and hospital-level variables are important to predict ATD.
药物洗脱支架植入术后第一年抗血小板治疗停药（ATD）的预测因素知之甚少。
这是一项前瞻性研究，对 2008 年 1 月至 4 月期间在 29 家医院接受至少 1 个药物洗脱支架的患者进行了 3、6、9 和 12 个月的随访。通过分层多项回归分析评估个体和医院水平的 ATD 预测因素。可以对 1622 名接受随访的候选人（82.5%）进行 ATD 评估。共有 234 名患者（14.4%）中断了至少 1 种抗血小板药物治疗，主要是氯吡格雷（n=182，11.8%）。出血事件或侵入性操作导致 109 名患者 ATD。肾功能不全（优势比[OR]2.81，95%置信区间[CI]1.48 至 5.34）、既往大出血（OR 3.77，95%CI 1.41 至 10.03）和外周动脉疾病（OR 1.78，95%CI 1.01 至 3.15）预测 ATD。70 名患者因医疗决策而中断 ATD；这与长期抗凝治疗（OR 3.88，95%CI 1.26 至 11.98）、在私立医院接受手术（OR 13.3，95%CI 1.69 至 105）和未接受药物使用说明（OR 2.8，95%CI 1.23 至 6.36）有关。39 名患者主动中断 ATD，主要是移民（OR 3.78，95%CI 1.2 至 11.98）和使用精神药物的患者（OR 2.58，95%CI 1.3 至 5.12）。
药物洗脱支架植入术后第一年的 ATD 主要基于患者决策或与大出血事件或重大手术无关的医疗决策。个体和医院水平的变量对预测 ATD 很重要。
