Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, 33, Linsen South Road, Taipei, Taiwan.
BMC Cardiovasc Disord. 2014 Feb 18;14:21. doi: 10.1186/1471-2261-14-21.
The optimal duration of dual antiplatelet therapy after percutaneous coronary intervention (PCI) remains uncertain. The objective of this study was to examine the association between duration of dual antiplatelet therapy and re-hospitalization for acute coronary syndrome (ACS) in ACS patients who underwent PCI.
We identified 975 newly diagnosed ACS patients who underwent PCI between July, 2007 and June, 2009, at a medical center in Taiwan. Cox proportional hazard models were used to examine the association between duration of dual antiplatelet therapy (9 months, 12 months and 15 months) and risks of re-hospitalization for ACS.
At a mean follow-up of 2.3 years, we found that use of clopidogrel for ≥ 12 months was associated with a decreased risk of re-hospitalization for ACS (adjusted HR 0.59, 95% CI 0.36-0.95; p = 0.03). However, use of clopidogrel for ≥ 15 months was not associated with a decreased risk of re-hospitalization for ACS (adjusted HR 0.57, 95% CI 0.29-1.13; p = 0.11). Similar results were found in patients who implanted drug-eluting stents (DES), for whom at least 12 months of clopidogrel therapy is especially critical.
The benefit of ≥ 12 months of clopidogrel use in reducing the risk of re-hospitalization for ACS was significant among ACS patients who underwent PCI and was especially critical for those who implanted DES.
经皮冠状动脉介入治疗（PCI）后双联抗血小板治疗的最佳持续时间仍不确定。本研究旨在探讨 PCI 后急性冠状动脉综合征（ACS）患者双联抗血小板治疗时间与因 ACS 再住院之间的关系。
我们在台湾的一家医疗中心确定了 975 例 2007 年 7 月至 2009 年 6 月期间新诊断为 ACS 且接受 PCI 的患者。使用 Cox 比例风险模型来检验双联抗血小板治疗（9 个月、12 个月和 15 个月）与 ACS 再住院风险之间的关系。
平均随访 2.3 年后，我们发现使用氯吡格雷≥12 个月与 ACS 再住院风险降低相关（调整后的 HR 0.59，95%CI 0.36-0.95；p=0.03）。然而，使用氯吡格雷≥15 个月与 ACS 再住院风险降低无关（调整后的 HR 0.57，95%CI 0.29-1.13；p=0.11）。在植入药物洗脱支架（DES）的患者中也发现了类似的结果，对于这些患者，至少 12 个月的氯吡格雷治疗尤为关键。
在接受 PCI 的 ACS 患者中，氯吡格雷使用≥12 个月可显著降低 ACS 再住院风险，对于植入 DES 的患者尤为关键。
