Suh Soon Yong, Kang Woong Chol, Oh Pyung Chun, Choi Hanul, Moon Chan Il, Lee Kyounghoon, Han Seung Hwan, Ahn Taehoon, Choi In Suck, Shin Eak Kyun
Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Korea.
Heart Vessels. 2014 Sep;29(5):578-83. doi: 10.1007/s00380-013-0399-x. Epub 2013 Aug 24.
There are limited data on the optimal antithrombotic therapy for patients with atrial fibrillation (AF) who undergoing coronary stenting. We reviewed 203 patients (62.6 % men, mean age 68.3 ± 10.1 years) between 2003 and 2012, and recorded clinical and demographic characteristics of the patients. Clinical follow-up included major adverse cardiac and cerebrovascular events (MACCE) (cardiac death, myocardial infarction, target lesion revascularization, and stroke), stent thrombosis, and bleeding. The most commonly associated comorbidities were hypertension (70.4 %), diabetes mellitus (35.5 %), and congestive heart failure (26.6 %). Sixty-three percent of patients had stroke risk higher than CHADS2 score 2. At discharge, dual-antiplatelet therapy (aspirin, clopidogrel) was used in 166 patients (81.8 %; Group I), whereas 37 patients (18.2 %) were discharged with triple therapy (aspirin, clopidogrel, warfarin; Group II). The mean follow-up period was 42.0 ± 29.0 months. The mean international normalized ratio (INR) in group II was 1.83 ± 0.41. The total MACCE was 16.3 %, with stroke in 3.4 %. Compared with the group II, the incidence of MACCE (2.7 % vs 19.3 %, P = 0.012) and cardiac death (0 % vs 11.4 %, P = 0.028) were higher in the group I. Major and any bleeding, however, did not differ between the two groups. In multivariate analysis, no warfarin therapy (odds ratio 7.8, 95 % confidence interval 1.02-59.35; P = 0.048) was an independent predictor of MACCE. By Kaplan-Meier survival analysis, warfarin therapy was associated with a lower risk of MACCE (P = 0.024). In patients with AF undergoing coronary artery stenting, MACCE were reduced by warfarin therapy without increased bleeding, which might be related to tighter control with a lower INR value.
对于接受冠状动脉支架置入术的心房颤动（AF）患者，关于最佳抗栓治疗的数据有限。我们回顾了2003年至2012年间的203例患者（男性占62.6%，平均年龄68.3±10.1岁），记录了患者的临床和人口统计学特征。临床随访包括主要不良心脑血管事件（MACCE）（心源性死亡、心肌梗死、靶病变血运重建和中风）、支架血栓形成和出血。最常见的合并症为高血压（70.4%）、糖尿病（35.5%）和充血性心力衰竭（26.6%）。63%的患者中风风险高于CHADS2评分2分。出院时，166例患者（81.8%；I组）使用双联抗血小板治疗（阿司匹林、氯吡格雷），而37例患者（18.2%）出院时接受三联治疗（阿司匹林、氯吡格雷、华法林；II组）。平均随访期为42.0±29.0个月。II组的平均国际标准化比值（INR）为1.83±0.41。总的MACCE为16.3%，中风发生率为3.4%。与II组相比，I组的MACCE发生率（2.7%对19.3%，P = 0.012）和心源性死亡发生率（0%对11.4%，P = 0.028）更高。然而，两组之间的大出血和任何出血情况并无差异。在多变量分析中，未使用华法林治疗（比值比7.8，95%置信区间1.02 - 59.35；P = 0.048）是MACCE的独立预测因素。通过Kaplan - Meier生存分析，华法林治疗与较低的MACCE风险相关（P = 0.024）。在接受冠状动脉支架置入术的AF患者中，华法林治疗可降低MACCE且不增加出血，这可能与较低INR值的更严格控制有关。
