高龄患者药物洗脱支架置入术后长期双联抗血小板治疗的风险。

Risk of long-term dual antiplatelet therapy following drug-eluting stent implantation in octogenarians.

机构信息

Department of Cardiology, Shonan Kamakura General Hospital, 1370‐1 Okamoto, Kamakura, Kanagawa 247‐0072, Japan.

出版信息

J Interv Cardiol. 2013 Apr;26(2):114-22. doi: 10.1111/j.1540-8183.2013.12019.x. Epub 2013 Feb 5.

DOI:10.1111/j.1540-8183.2013.12019.x

PMID:23379754

Abstract

OBJECTIVES

To evaluate the risk of long-term dual antiplatelet therapy (DAT) following drug-eluting stent (DES) implantation in octogenarians.

BACKGROUND

DES implantation requires DAT; however, DAT-associated risk in octogenarians remains unclear.

METHODS

Two-hundred and six consecutive octogenarians (130 men, 83.3 ± 3.4 years) underwent stent implantation (104 bare metal stents [BMSs] and 102 DESs) and 38.0 ± 13.2 months of follow-up.

RESULTS

Significantly more DES patients received DAT. The incidence of bleeding events was similar in the DES and BMS groups for 1 year (total: 10.8% vs 5.8%, P = 0.19; major: 4.9% vs 2.9%, P = 0.70). However, after 2 years, significantly more bleeding events occurred in the DES group than the BMS group (total: 2 years, 21.6% vs 9.6%, P = 0.02; 3 years, 29.4% vs 11.5%, P = 0.001; 4 years, 31.4% vs 15.4%, P = 0.007; major: 2 years, 12.7% vs 3.8%, P = 0.04; 3 years, 18.6% vs 5.8%, P = 0.005; 4 years, 19.6% vs 6.7%, P = 0.006). Overall, significantly more total bleeding events (31.4% vs 15.4%, P = 0.007) and major bleeding events (19.2% vs 6.7%, P = 0.006) were observed in the DES group than in the BMS group. The adjusted hazard ratios and 95% confidence intervals (CI) were as follows: total bleeding events, 2.203 (95% CI: 1.065-4.556; P = 0.033); major bleeding events, 4.324 (1.506-12.414; P = 0.007).

CONCLUSIONS

DAT was associated with an increased risk of bleeding events in octogenarians after 2 years. DAT discontinuation should be considered for octogenarians 1-year post-DES implantation.

摘要

目的

评估老年患者接受药物洗脱支架（DES）植入后长期双联抗血小板治疗（DAT）的风险。

背景

DES 植入需要 DAT；然而，80 岁以上患者 DAT 的相关风险尚不清楚。

方法

206 例连续的 80 岁以上患者（130 名男性，83.3±3.4 岁）接受了支架植入（104 个裸金属支架 [BMS] 和 102 个 DES）和 38.0±13.2 个月的随访。

结果

DES 患者接受 DAT 的比例明显更高。DES 组和 BMS 组在 1 年时出血事件的发生率相似（总出血：10.8%比 5.8%，P=0.19；大出血：4.9%比 2.9%，P=0.70）。然而，2 年后，DES 组出血事件的发生率明显高于 BMS 组（总出血：2 年，21.6%比 9.6%，P=0.02；3 年，29.4%比 11.5%，P=0.001；4 年，31.4%比 15.4%，P=0.007；大出血：2 年，12.7%比 3.8%，P=0.04；3 年，18.6%比 5.8%，P=0.005；4 年，19.6%比 6.7%，P=0.006）。总体而言，DES 组的总出血事件（31.4%比 15.4%，P=0.007）和大出血事件（19.2%比 6.7%，P=0.006）明显多于 BMS 组。调整后的危险比和 95%置信区间（CI）如下：总出血事件，2.203（95%CI：1.065-4.556；P=0.033）；大出血事件，4.324（1.506-12.414；P=0.007）。