Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Can J Cardiol. 2011 Nov-Dec;27(6):711-5. doi: 10.1016/j.cjca.2011.06.003. Epub 2011 Aug 27.
Randomized trials have established the efficacy of clopidogrel in acute coronary syndromes (ACS). The benefit of clopidogrel has also been observed in the subgroup of ACS patients who subsequently undergo coronary artery bypass surgery (CABG); however, this therapy is discontinued preoperatively and the frequency with which clopidogrel is restarted post-CABG is unknown.
We examined the pattern of clopidogrel use in the Canadian Global Registry of Acute Coronary Events (GRACE), GRACE2, and CANRACE (2003-2008) post-CABG ACS patients. We stratified the patients according to whether they underwent CABG during their index hospitalization for ACS and whether they were prescribed clopidogrel at discharge.
Among those patients in whom clopidogrel status at discharge was known, 5904 (60%) of 9841 were discharged from hospital on clopidogrel. Use of clopidogrel at discharge was observed in 2222 (40.8%) of 5443 patients who were medically managed (ie, did not undergo percutaneous coronary intervention [PCI] or CABG) and in 3585 (90.1%) of 3980 patients who underwent in-hospital PCI. Overall, 455 (3.3%) of 13,776 patients underwent CABG during the index hospitalization; 255 (56%) patients were started on clopidogrel during the first 24 hours, and 66 of these patients (25.9%) were discharged on clopidogrel. In contrast, 5681 (61.3%) of the 9262 patients who did not undergo in-hospital CABG were discharged on clopidogrel.
Although current guidelines recommend the use of clopidogrel post-CABG in patients with ACS, our observations suggest that only 1 in 4 or 5 Canadian patients are discharged on this therapy.
随机试验已经证实氯吡格雷在急性冠脉综合征（ACS）中的疗效。ACS 患者亚组随后行冠状动脉旁路移植术（CABG）也观察到氯吡格雷的获益；然而，这种治疗在术前被停用，并且 CABG 术后氯吡格雷重新开始使用的频率尚不清楚。
我们检查了加拿大急性冠脉事件全球注册（GRACE）、GRACE2 和 CANRACE（2003-2008 年）中 CABG 后 ACS 患者的氯吡格雷使用模式。我们根据患者在 ACS 指数住院期间是否行 CABG 以及出院时是否开具氯吡格雷将患者分层。
在出院时已知氯吡格雷状态的患者中，9841 例中的 5904 例（60%）出院时服用氯吡格雷。在接受药物治疗（即未行经皮冠状动脉介入治疗[PCI]或 CABG）的 5443 例患者中，有 2222 例（40.8%）和在接受院内 PCI 的 3980 例患者中，有 3585 例（90.1%）出院时开具氯吡格雷。总体而言，13776 例患者中的 455 例（3.3%）在指数住院期间行 CABG；255 例（56%）患者在最初 24 小时内开始使用氯吡格雷，其中 66 例（25.9%）患者出院时服用氯吡格雷。相比之下，9262 例未行院内 CABG 的患者中有 5681 例（61.3%）出院时服用氯吡格雷。
尽管目前的指南建议 ACS 患者 CABG 后使用氯吡格雷，但我们的观察结果表明，只有 1/4 或 1/5 的加拿大患者出院时使用这种治疗。
