Nakamura Masato, Yamagishi Masakazu, Ueno Takafumi, Hara Kazuhiro, Ishiwata Sugao, Itoh Tomonori, Hamanaka Ichiro, Wakatsuki Tetsuzo, Sugano Teruyasu, Kawai Kazuya, Kimura Takeshi
Division of Cardiovascular Medicine, Toho University School of Medicine, Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
Cardiovasc Interv Ther. 2013 Apr;28(2):162-9. doi: 10.1007/s12928-012-0146-8. Epub 2012 Dec 13.
Antiplatelet therapy could prevent stent thrombosis, but may be associated with an increased risk of bleeding. Recent studies have revealed that bleeding complications are relatively frequent in patients with acute coronary syndromes. Our aim was to describe the current status of antiplatelet therapy for Japanese patients with acute myocardial infarction (AMI). The Japan AMI (J-AMI) registry is a prospective observational study that has enrolled 2,030 consecutive patients with stent thrombosis elevation myocardial infarction (STEMI) admitted to 213 participating Japanese institutions. Current antiplatelet therapy for STEMI was assessed, and the occurrence of bleeding complications (based on GUSTO bleeding criteria) and stent thrombosis was also evaluated. Additionally, the clinical course after bleeding episodes was investigated. Percutaneous coronary intervention (PCI) was done in 97.2% of the patients, using a drug-eluting stent in 30% and a bare metal stent in 63% of PCI cases. A 300-mg loading dose of clopidogrel followed by its administration at 75 mg/day with aspirin was the current standard treatment for Japanese STEMI patients. In-hospital bleeding complications occurred in 1.9%, especially in patients with severe clinical features or a history of cerebrovascular disease. Moderate to severe bleeding complications were associated with 10 deaths. The in-hospital stent thrombosis (ST) rate was 1.47 %, and loading with clopidogrel prior to PCI was significantly less frequent in patients who developed ST (P < 0.001). In conclusion, the J-AMI registry revealed that severe symptoms of STEMI increased the risk of bleeding, while delay of clopidogrel loading was associated with ST. These findings suggest the need for treatment based on risk stratification to improve the balance between the beneficial and adverse effects of antiplatelet therapy in Japanese STEMI patients.
抗血小板治疗可预防支架内血栓形成，但可能会增加出血风险。最近的研究表明，急性冠状动脉综合征患者出血并发症相对常见。我们的目的是描述日本急性心肌梗死（AMI）患者抗血小板治疗的现状。日本AMI（J-AMI）注册研究是一项前瞻性观察性研究，已连续纳入213家参与研究的日本机构收治的2030例支架内血栓形成抬高型心肌梗死（STEMI）患者。评估了目前STEMI的抗血小板治疗情况，并评估了出血并发症（基于GUSTO出血标准）和支架内血栓形成的发生情况。此外，还调查了出血事件后的临床病程。97.2%的患者接受了经皮冠状动脉介入治疗（PCI），其中30%的PCI病例使用药物洗脱支架，63%使用裸金属支架。目前日本STEMI患者的标准治疗是给予300mg负荷剂量的氯吡格雷，随后以75mg/天的剂量与阿司匹林联合使用。住院期间出血并发症发生率为1.9%，尤其在具有严重临床特征或有脑血管疾病史的患者中。中度至重度出血并发症导致10例死亡。住院期间支架内血栓形成（ST）率为1.47%，发生ST的患者在PCI前给予氯吡格雷负荷剂量的频率显著较低（P<0.001）。总之，J-AMI注册研究表明，STEMI的严重症状增加了出血风险，而氯吡格雷负荷延迟与ST相关。这些发现提示，在日本STEMI患者中，需要根据风险分层进行治疗，以改善抗血小板治疗利弊之间的平衡。
