Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK.
Cardiovasc Ther. 2014 Feb;32(1):1-6. doi: 10.1111/1755-5922.12051.
Primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is a therapeutic success when supported by dual antiplatelet therapy. Prasugrel has been introduced as a potential alternative to clopidogrel alongside aspirin. We aimed to assess prasugrel versus clopidogrel mortality outcomes in patients admitted with STEMI undergoing PPCI.
Retrospective analysis of prospectively collected data of 1688 consecutive STEMI patients undergoing PPCI at a regional tertiary centre. Patients with age ≥75 years, weight<60 kg or history of cerebrovascular accident or TIA's, active bleeding or known hepatic impairment were excluded. All patients from March 2008 to 16 December 2009 belong to the Clopidogrel group and from 17 December 2009 to June 2011 belong to the Prasugrel group.
A total of 866 patients were in the Clopidogrel group and 822 patients in the prasugrel group. In-hospital mortality was 1.7% in the Clopidogrel and 1.5% in Prasugrel group (P = 0.40). 30-day postdischarge mortality was 2.4% and 1.8% (P = 0.25) in the Clopidogrel and Prasugrel group, respectively. One-year mortality rate was recorded in 62 patients (3.7%): 39 (4.5%) in the Clopidogrel group and 23 (2.8%) in the prasugrel group. In the Cox proportional hazard model, the adjusted hazard ratio for all-cause mortality for the prasugrel group was 0.47 (95% CI: 0.253-0.881; P = 0.018). Independent predictors of one-year mortality postdischarge were age, admission creatinine and haemoglobin, admission heart rate, total ischaemic time, the presence of multivessel coronary artery disease, previous MI and post-PCI TIMI flow.
In PPCI-treated STEMI patients, prasugrel is associated with a significant reduction in one-year mortality compared with clopidogrel.
ST 段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PPCI）时，双联抗血小板治疗可提高治疗成功率。普拉格雷已被推荐为氯吡格雷联合阿司匹林的替代药物。我们旨在评估 STEMI 患者行 PPCI 时应用普拉格雷和氯吡格雷的死亡率结局。
回顾性分析在一家地区性三级中心行 PPCI 的 1688 例连续 STEMI 患者的前瞻性采集数据。排除年龄≥75 岁、体重<60kg 或有脑血管意外或短暂性脑缺血发作史、有活动性出血或已知肝功能损害的患者。所有患者中，2008 年 3 月至 2009 年 12 月 16 日接受氯吡格雷治疗，2009 年 12 月 17 日至 2011 年 6 月接受普拉格雷治疗。
共 866 例患者接受氯吡格雷治疗，822 例患者接受普拉格雷治疗。氯吡格雷组住院期间死亡率为 1.7%，普拉格雷组为 1.5%（P=0.40）。氯吡格雷组和普拉格雷组的 30 天出院后死亡率分别为 2.4%和 1.8%（P=0.25）。62 例患者（3.7%）记录到 1 年死亡率：氯吡格雷组 39 例（4.5%），普拉格雷组 23 例（2.8%）。在 Cox 比例风险模型中，普拉格雷组全因死亡率的调整后危险比为 0.47（95%CI：0.253-0.881；P=0.018）。出院后 1 年死亡率的独立预测因素为年龄、入院时肌酐和血红蛋白、入院时心率、总缺血时间、多支冠状动脉疾病、既往心肌梗死和 PCI 后 TIMI 血流。
在 STEMI 患者行 PPCI 治疗时，与氯吡格雷相比，普拉格雷可显著降低 1 年死亡率。
