Cardiac Catheterization Laboratory, Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA.
J Interv Cardiol. 2012 Oct;25(5):482-92. doi: 10.1111/j.1540-8183.2012.00746.x. Epub 2012 Jun 22.
To define the incidence of stent thrombosis (ST) and/or AMI (ST/AMI) associated with temporary or permanent suspension of dual antiplatelet therapy (DAPT) after coronary drug-eluting stent (DES) implantation in "real-world" patients, and additional factors influencing these events.
Adherence to DAPT is critical for avoiding ST following DES implantation. However, the outcomes of patients undergoing antiplatelet therapy withdrawal following DES implantation remain to be clearly described.
Patients receiving DES from 05/01/2003 to 05/01/2008 were identified from a single-center registry. Complete follow-up data were available for 5,681 patients (67% male, age 66 ± 11 years, duration 1,108 ± 446 days) who were included in this analysis.
Uninterrupted DAPT was maintained in 4,070/5,681 (71.6%) patients, with an annual ST/AMI rate of 0.43%. Antiplatelet therapy was commonly ceased for gastrointestinal-related issues, dental procedures or noncardiac/nongastrointestinal surgery. Temporary DAPT suspension occurred in 593/5,681 (10.4%) patients for 17.6 ± 74.1 days, with 6/593 (1.0%) experiencing ST/AMI during this period. Of patients permanently ceasing aspirin (n = 187, mean 338 ± 411 days poststenting), clopidogrel (n = 713, mean 614 ± 375 days) or both agents (n = 118, mean 459 ± 408 days), ST/AMI was uncommon with an annual rate of 0.1-0.2%. Overall, independent predictors of ST/AMI were unstable initial presentation, uninterrupted DAPT and lower left ventricular ejection fraction. Factors predicting uninterrupted DAPT included diabetes, unstable presentation, prior MI, left main coronary PCI, and multivessel coronary disease.
In real-world practice, rates of ST/AMI following DES implantation are low, but not insignificant, following aspirin and/or clopidogrel cessation. Use of uninterrupted DAPT appears more common in high-risk patients.
定义在冠状动脉药物洗脱支架（DES）植入后，因临时或永久停止双联抗血小板治疗（DAPT）而导致支架血栓形成（ST）和/或急性心肌梗死（AMI）（ST/AMI）的发生率，以及影响这些事件的其他因素。
遵循 DAPT 对于避免 DES 植入后发生 ST 至关重要。然而，DES 植入后停止抗血小板治疗的患者的结局仍有待明确描述。
从一个单中心登记处确定 2003 年 5 月 1 日至 2008 年 5 月 1 日期间接受 DES 的患者。这项分析纳入了 5681 例（67%为男性，年龄 66 ± 11 岁，随访时间 1108 ± 446 天）患者的完整随访数据。
4070/5681（71.6%）例患者未中断 DAPT，每年 ST/AMI 发生率为 0.43%。抗血小板治疗通常因胃肠道相关问题、牙科手术或非心脏/非胃肠道手术而停止。593/5681（10.4%）例患者临时停止 DAPT 治疗，时间为 17.6 ± 74.1 天，在此期间有 6/593（1.0%）例患者发生 ST/AMI。永久性停用阿司匹林（n = 187，支架植入后平均 338 ± 411 天）、氯吡格雷（n = 713，平均 614 ± 375 天）或两种药物（n = 118，平均 459 ± 408 天）的患者中，ST/AMI 并不常见，年发生率为 0.1-0.2%。总体而言，ST/AMI 的独立预测因素为不稳定的初始表现、未中断 DAPT 和较低的左心室射血分数。预测未中断 DAPT 的因素包括糖尿病、不稳定的表现、既往心肌梗死、左主干冠状动脉 PCI 和多支冠状动脉疾病。
在真实世界的实践中，DES 植入后 ST/AMI 的发生率较低，但阿司匹林和/或氯吡格雷停药后并非微不足道。未中断 DAPT 的使用似乎更常见于高危患者。
