Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard Clinical Research Institute, Boston, MA, USA.
Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard Clinical Research Institute, Boston, MA, USA.
Lancet. 2015 Feb 28;385(9970):792-8. doi: 10.1016/S0140-6736(14)62052-3. Epub 2014 Nov 16.
Treatment with aspirin and a P2Y12 inhibitor is commonly used in patients with cardiovascular disorders. The overall effect of such treatment on all-cause mortality is unknown. In the Dual Antiplatelet Therapy (DAPT) Study, continuation of dual antiplatelet therapy beyond 12 months after coronary stenting was associated with an unexpected increase in non-cardiovascular death. In view of the potential public health importance of these findings, we aimed to assess the effect of extended duration dual antiplatelet therapy on mortality by doing a meta-analysis of all randomised, controlled trials of treatment duration in various cardiovascular disorders.
We searched Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomised controlled trials assessing the effect of extended duration versus no or short duration dual antiplatelet therapy, published before Oct 1, 2014. We did a meta-analysis to pool results with a hierarchical Bayesian random-effects model. The primary outcomes were hazard ratios comparing rates of all-cause, cardiovascular, and non-cardiovascular death.
Including the DAPT Study, we identified 14 eligible trials that randomly assigned 69,644 participants to different durations of dual antiplatelet therapy. Compared with aspirin alone or short duration dual antiplatelet therapy (≤6 months), continued treatment was not associated with a difference in all-cause mortality (hazard ratio [HR] 1·05, 95% credible interval [CrI] 0·96-1·19; p=0·33). Similarly, cardiovascular (1·01, 0·93-1·12; p=0·81) and non-cardiovascular mortality (1·04, 0·90-1·26; p=0·66) were no different with extended duration versus short duration dual antiplatelet therapy or aspirin alone.
Extended duration dual antiplatelet therapy was not associated with a difference in the risk of all-cause, cardiovascular, or non-cardiovascular death compared with aspirin alone or short duration dual antiplatelet therapy.
None.
在心血管疾病患者中，常采用阿司匹林和 P2Y12 抑制剂联合治疗。目前尚不清楚这种治疗方法对全因死亡率的整体影响。在双联抗血小板治疗（DAPT）研究中，冠状动脉支架置入后 12 个月以上继续双联抗血小板治疗会导致非心血管死亡的意外增加。鉴于这些发现可能具有重要的公共卫生意义，我们旨在通过对各种心血管疾病中治疗持续时间的随机对照试验进行荟萃分析，评估延长双联抗血小板治疗时间对死亡率的影响。
我们检索了 Medline、Embase 和 Cochrane 对照试验中心注册库（CENTRAL），以确定评估延长持续时间与无或短持续时间双联抗血小板治疗效果的随机对照试验，这些试验的发表时间均早于 2014 年 10 月 1 日。我们采用分层贝叶斯随机效应模型进行荟萃分析以汇总结果。主要结局是比较全因死亡率、心血管死亡率和非心血管死亡率的风险比。
包括 DAPT 研究在内，我们共确定了 14 项符合条件的试验，这些试验将 69644 名参与者随机分配至不同持续时间的双联抗血小板治疗组。与阿司匹林单药或短持续时间双联抗血小板治疗（≤6 个月）相比，继续治疗与全因死亡率无差异（风险比 [HR] 1.05，95%可信区间 [CrI] 0.96-1.19；p=0.33）。同样，心血管死亡率（1.01，0.93-1.12；p=0.81）和非心血管死亡率（1.04，0.90-1.26；p=0.66）在延长持续时间与短持续时间双联抗血小板治疗或阿司匹林单药治疗之间也无差异。
与阿司匹林单药或短持续时间双联抗血小板治疗相比，延长持续时间的双联抗血小板治疗并未增加全因、心血管或非心血管死亡的风险。
延长持续时间的双联抗血小板治疗并未增加全因、心血管或非心血管死亡的风险。
