在接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中，使用 P2Y12 即时检验（point-of-care assay）进行新的双联抗血小板治疗（阿司匹林、普拉格雷）与三联抗血小板治疗（阿司匹林、氯吡格雷、西洛他唑）的随机比较。
Randomized comparison of new dual-antiplatelet therapy (aspirin, prasugrel) and triple-antiplatelet therapy (aspirin, clopidogrel, cilostazol) using P2Y12 point-of-care assay in patients with STEMI undergoing primary PCI.
机构信息
Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Cardiovascular Research Institute, Busan Paik Hospital, Busan, South Korea.
出版信息
Int J Cardiol. 2013 Sep 20;168(1):207-11. doi: 10.1016/j.ijcard.2012.09.093. Epub 2012 Oct 26.
BACKGROUND
Both new dual antiplatelet therapy (DAT; aspirin and prasugrel) and triple antiplatelet therapy (TAT; aspirin, clopidogrel and cilostazol) are more potent than classic DAT (aspirin and clopidogrel). We compared the antiplatelet efficacy between new DAT and TAT in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary coronary percutaneous coronary intervention (PCI).
METHODS
Forty patients who were eligible for primary PCI were prospectively randomized to DAT group (n=20) or TAT group (n=20) immediately after hospital arrival. The primary end point was P2Y12 reaction unit (PRU) determined with the VerifyNow P2Y12 point-of-care assay at the time of discharge.
RESULTS
PRU value at discharge was significantly lower in patients receiving DAT compared with that of TAT (84.5 ± 44.7 vs. 128.4 ± 74.9, p=0.032). Percent platelet inhibition was significantly higher for DAT compared with TAT at discharge (72.1 ± 12.2 vs. 57.5 ± 23.5, p=0.020). Inter-patient variability of PRU values at discharge was significantly smaller in patient taking DAT compared with TAT (p=0.026).
CONCLUSION
A new DAT is more potent antiplatelet therapy than TAT in patients with STEMI undergoing primary PCI.
背景
新型双联抗血小板治疗（DAT；阿司匹林和普拉格雷）和三联抗血小板治疗（TAT；阿司匹林、氯吡格雷和西洛他唑）均比经典双联抗血小板治疗（DAT；阿司匹林和氯吡格雷）更有效。我们比较了在接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中新型 DAT 和 TAT 的抗血小板疗效。
方法
40 名符合直接 PCI 条件的患者在入院后立即前瞻性随机分为 DAT 组（n=20）或 TAT 组（n=20）。主要终点是通过即时检验（POC）VerifyNow P2Y12 血小板反应单位（PRU）测定在出院时的 P2Y12 反应单位（PRU）。
结果
与 TAT 相比，DAT 组患者出院时的 PRU 值明显较低（84.5±44.7 与 128.4±74.9，p=0.032）。与 TAT 相比，DAT 组在出院时的血小板抑制率更高（72.1±12.2 与 57.5±23.5，p=0.020）。与 TAT 相比，DAT 组患者出院时 PRU 值的个体间变异性明显较小（p=0.026）。
结论
与 TAT 相比，在接受直接 PCI 的 STEMI 患者中，新型 DAT 是一种更有效的抗血小板治疗方法。
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