Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
J Am Coll Cardiol. 2011 Mar 8;57(10):1202-9. doi: 10.1016/j.jacc.2010.09.069.
The objective of this study was to examine the clinical efficacy of clopidogrel treatment on death and recurrent myocardial infarction (MI) among MI patients revascularized by coronary artery bypass graft surgery (CABG).
The benefit from post-operative clopidogrel in CABG-treated MI patients is largely unknown.
All patients admitted with first-time MI between 2002 and 2006, treated with CABG within 180 days after admission, were identified by nationwide administrative registers. Clopidogrel treatment was determined by claimed prescriptions after discharge from surgery. Risk of death or recurrent MI, and of a combined end point of the 2, were assessed by cumulative incidence and Cox proportional hazards model. A propensity score-matched subgroup analysis was done.
We included 3,545 patients, and of these, 957 (27.0%) were treated with clopidogrel after CABG. Mean follow-up was 466 ± 144 days. Among patients treated with clopidogrel, 39 (4.1%) died or experienced a recurrent MI, whereas that occurred in 203 (7.8%) patients without clopidogrel (log-rank p = 0.0003). Hazard ratio was 0.59 (95% confidence interval [CI]: 0.42 to 0.85) for patients treated with clopidogrel, with no-clopidogrel as reference. By propensity score, of 945 patients with or without clopidogrel treatment who were matched, death or recurrent MI occurred in 38 (4.0%) patients with clopidogrel and 57 (6.0%) without clopidogrel (log-rank p = 0.05). Corresponding hazard ratio was 0.67 (95% CI: 0.44 to 1.00) for clopidogrel users, with no-clopidogrel as reference.
Among MI patients revascularized by CABG, only 27% received clopidogrel after discharge. Clopidogrel-treated patients had a lower risk of the combined end point of death or recurrent MI. Focus on discharge clopidogrel treatment of these patients should be made.
本研究旨在探讨氯吡格雷治疗对行冠状动脉旁路移植术（CABG）的心肌梗死（MI）患者死亡和再发心肌梗死（MI）的临床疗效。
术后氯吡格雷在 CABG 治疗的 MI 患者中的获益尚不清楚。
通过全国性行政登记，确定 2002 年至 2006 年期间首次发生 MI 且在入院后 180 天内接受 CABG 治疗的所有患者。根据术后出院后的用药处方确定氯吡格雷的治疗情况。通过累积发生率和 Cox 比例风险模型评估死亡或再发 MI 的风险，以及这两个终点的联合风险。进行倾向评分匹配亚组分析。
共纳入 3545 例患者，其中 957 例（27.0%）在 CABG 后接受氯吡格雷治疗。平均随访时间为 466±144 天。在接受氯吡格雷治疗的患者中，39 例（4.1%）死亡或再发 MI，而未接受氯吡格雷治疗的患者中有 203 例（7.8%）发生该事件（log-rank p=0.0003）。以未接受氯吡格雷治疗的患者为参照，接受氯吡格雷治疗的患者的危险比为 0.59（95%置信区间：0.42 至 0.85）。通过倾向评分，对有或无氯吡格雷治疗的 945 例患者进行匹配，在接受氯吡格雷治疗的患者中有 38 例（4.0%）和未接受氯吡格雷治疗的患者中有 57 例（6.0%）发生死亡或再发 MI（log-rank p=0.05）。以未接受氯吡格雷治疗的患者为参照，接受氯吡格雷治疗的患者的危险比为 0.67（95%置信区间：0.44 至 1.00）。
在接受 CABG 血运重建的 MI 患者中，仅有 27%的患者在出院后接受氯吡格雷治疗。接受氯吡格雷治疗的患者死亡或再发 MI 的风险较低。应关注这些患者的出院后氯吡格雷治疗。
