USC Cardiologia, Dipartimento Cardiovascolare, Ospedali Riuniti di Bergamo, Italy.
Am J Cardiol. 2011 Jan 15;107(2):186-94. doi: 10.1016/j.amjcard.2010.08.067.
To date, limited information is available on the long-term discontinuation rates of antiplatelet therapy after drug-eluting stent implantation. The aim of the present study was to determine the prevalence and predictors of premature discontinuation of oral antiplatelet therapy after drug-eluting stent implantation and to evaluate its effects on long-term prognosis. We studied 1,358 consecutive patients successfully treated with drug-eluting stents and discharged with dual oral antiplatelet therapy. Aspirin was to be maintained lifelong, and clopidogrel was prescribed for 12 months. The patients were followed for 36 months. The prevalence and predictors of aspirin and clopidogrel discontinuation were assessed. Major adverse cardiac events, defined as death, myocardial infarction, destabilizing symptoms leading to hospitalization, and nonfatal stroke, were recorded. Definite, probable, and possible stent thrombosis (ST) and major and minor bleeding were also determined. Of the 1,358 patients, 8.8% had discontinued one or both antiplatelet agents within the first 12 months ("early" discontinuation) and 4.8% had discontinued aspirin after 1 year ("late" discontinuation). Early discontinuation was predicted by in-hospital major bleeding, the use of oral anticoagulants at discharge, and the lack of a statin prescription. Previous stroke was the only independent predictor of late discontinuation. Patients with early discontinuation experienced a greater incidence of major adverse cardiac events (28.6% vs 13.7%, p <0.001) and ST (7.6% vs 3.4%, p = 0.038). All-cause mortality (13.4% vs 4.7%, p <0.001) and cardiovascular death (5% vs 1.2%, p = 0.007) were significantly more frequent among patients with early discontinuation. In patients with late discontinuation, a nonstatistically significant increase was seen in major adverse cardiac events (20% vs 13.3%, p = 0.128) and ST (6.2% vs 3.2%, p = 0.275). In conclusion, premature discontinuation of antiplatelet therapy is relatively common, especially within the first year, and strongly associated with increased cardiovascular events, including ST and death.
迄今为止，关于药物洗脱支架置入后抗血小板治疗的长期停药率，相关信息有限。本研究旨在确定药物洗脱支架置入后口服抗血小板治疗过早停药的发生率和预测因素，并评估其对长期预后的影响。我们研究了 1358 例成功接受药物洗脱支架治疗并出院时接受双联口服抗血小板治疗的连续患者。阿司匹林需终身服用，氯吡格雷则需服用 12 个月。对患者进行了 36 个月的随访。评估了阿司匹林和氯吡格雷停药的发生率和预测因素。主要不良心脏事件定义为死亡、心肌梗死、导致住院的不稳定症状和非致死性卒中。确定、可能和极可能的支架血栓形成（ST）以及大出血和小出血也进行了评估。在 1358 例患者中，8.8%的患者在最初 12 个月内停用了一种或两种抗血小板药物（“早期”停药），4.8%的患者在 1 年后停用了阿司匹林（“晚期”停药）。早期停药的预测因素为住院期间大出血、出院时使用口服抗凝剂和未开具他汀类药物处方。既往卒中是晚期停药的唯一独立预测因素。早期停药的患者发生主要不良心脏事件（28.6% vs. 13.7%，p <0.001）和 ST（7.6% vs. 3.4%，p = 0.038）的发生率更高。所有原因死亡率（13.4% vs. 4.7%，p <0.001）和心血管死亡率（5% vs. 1.2%，p = 0.007）在早期停药的患者中明显更高。在晚期停药的患者中，主要不良心脏事件（20% vs. 13.3%，p = 0.128）和 ST（6.2% vs. 3.2%，p = 0.275）的发生率虽略有升高，但无统计学意义。总之，抗血小板治疗过早停药较为常见，尤其是在最初的 1 年内，与心血管事件增加密切相关，包括 ST 和死亡。
