Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, and Red de Enfermedades Cardiovasculares (RECAVA), Barcelona, Spain.
J Am Coll Cardiol. 2012 Oct 9;60(15):1333-9. doi: 10.1016/j.jacc.2012.04.057. Epub 2012 Sep 19.
The goal of this study was to assess the risk associated with double antiplatelet therapy (DAT) discontinuation, and specifically, temporary discontinuation, during the first year after drug-eluting stent (DES) implantation.
Doubts remain about the risk of temporary DAT discontinuation within 1 year after DES implantation.
A total of 1,622 consecutive patients undergoing DES implantation at 29 hospitals were followed up at 3, 6, 9, and 12 months to record the 1-year antiplatelet therapy discontinuation (ATD) rate, the number of days without DAT, and the rate of 1-year major cardiac events. Cox regression was used to analyze the association between ATD considered as a time-dependent covariate and 1-year cardiac events.
One hundred seventy-two (10.6%) patients interrupted at least 1 antiplatelet drug during the first year after DES implantation, although only 1 during the first month. Most (n=111, 64.5%) interrupted DAT temporarily (median: 7 days; range: 5 to 8.5): 79 clopidogrel (31 temporarily), 38 aspirin (27 temporarily), and 55 both drugs (53 temporarily). Discontinuation was followed by acute coronary syndrome in 7 (4.1%; 95% confidence interval [CI]: 1.7 to 8.2), a similar rate of major cardiac events to that in patients without ATD (n=80; 5.5%; 95% CI: 4.4 to 6.8; p=0.23). ATD was not independently associated with 1-year major cardiac events (hazard ratio: 1.32 [95% CI: 0.56 to 3.12]).
ATD within the first year and beyond the first month after DES is not exceptional, is usually temporary, and does not appear to have a large impact on risk.
本研究旨在评估药物洗脱支架（DES）植入后 1 年内双联抗血小板治疗（DAT）停药，特别是临时停药的风险。
DES 植入后 1 年内临时 DAT 停药风险仍存在疑问。
共纳入 29 家医院的 1622 例连续行 DES 植入的患者，在术后 3、6、9 和 12 个月时进行随访，记录 1 年内抗血小板治疗停药（ATD）率、无 DAT 天数和 1 年内主要心脏不良事件发生率。采用 Cox 回归分析将 ATD 作为时间相关协变量与 1 年心脏不良事件之间的关系。
172 例（10.6%）患者在 DES 植入后 1 年内至少中断过 1 种抗血小板药物，尽管只有 1 例在第 1 个月中断。大多数（n=111，64.5%）患者临时中断 DAT（中位数：7 天；范围：5 至 8.5 天）：79 例氯吡格雷（31 例临时）、38 例阿司匹林（27 例临时）和 55 例双联药物（53 例临时）。停药后 7 例（4.1%；95%置信区间[CI]：1.7 至 8.2）发生急性冠脉综合征，与未停药患者（n=80；5.5%；95%CI：4.4 至 6.8；p=0.23）的主要心脏不良事件发生率相似。ATD 与 1 年内主要心脏不良事件无独立相关性（风险比：1.32[95%CI：0.56 至 3.12]）。
DES 植入后 1 年内及 1 个月后发生 ATD 并不罕见，通常是临时的，似乎对风险影响不大。
