Goodman Shaun G, Nicolau Jose C, Requena Gema, Maguire Andrew, Blankenberg Stefan, Chen Ji Yan, Granger Christopher B, Grieve Richard, Pocock Stuart J, Simon Tabassome, Yasuda Satoshi, Vega Ana Maria, Brieger David
Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Canada.
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Int J Cardiol. 2017 Jun 1;236:54-60. doi: 10.1016/j.ijcard.2017.02.062. Epub 2017 Feb 21.
To describe contemporary patient characteristics and treatment patterns, including antithrombotic management, of post-myocardial infarction (MI) stable coronary artery disease (CAD) patients at high atherothrombotic risk from different geographical regions.
Patients ≥50years with prior MI 1-3years ago and ≥1 risk factor (age ≥65years, diabetes, 2nd prior MI >1yr ago, multivessel CAD, creatinine clearance 15-<60ml/min) were enrolled by 369 physicians (96% cardiologists) in 25 countries (2013-14) in the prospective TIGRIS study (NCT01866904).
9225 patients were enrolled (median 1.8years) post-MI: 52% with prior ST-elevation MI, median age 67years, 24% women, 67% Caucasian, 55% had ≥2 additional qualifying risk factors, 14% current smokers, 67% overweight/obese, 34% with blood pressure ≥140/90mmHg. 81% underwent percutaneous coronary intervention (PCI; 66% with drug-eluting stents) for the index MI. 75% of patients had been discharged on dual antiplatelet therapy (DAPT; acetylsalicylic acid [ASA]+ADP receptor inhibitor [ADPri]), mainly clopidogrel (75%). 63% had discontinued antiplatelet treatment (60% ADPri) around 1year, most commonly by physician recommendation (90%). At enrolment, 97% were taking an antithrombotic drug, most commonly ASA (88%), with 27% on DAPT (median duration 1.6years); continued DAPT >1year was highest (39%) in Asia-Pacific and lowest (12%) in Europe.
Despite guideline recommendations, 1 in 4 post-MI patients did not receive DAPT for ~1year. In contrast to guideline recommendations supporting newer ADPris, clopidogrel was mainly prescribed. Prior to recent RCT data supporting DAPT >1year post-MI/PCI, >1 in 4 patients have continued on DAPT, though with substantial international variability.
描述来自不同地理区域的具有高动脉粥样硬化血栓形成风险的心肌梗死（MI）后稳定型冠状动脉疾病（CAD）患者的当代患者特征和治疗模式，包括抗栓治疗管理。
在2013 - 2014年，来自25个国家的369名医生（96%为心脏病专家）纳入了前瞻性TIGRIS研究（NCT01866904）中年龄≥50岁、1 - 3年前有过心肌梗死且有≥1个危险因素（年龄≥65岁、糖尿病、1年多以前的第二次心肌梗死、多支冠状动脉疾病、肌酐清除率15 - <60ml/min）的患者。
9225例患者在心肌梗死后入组（中位时间1.8年）：52%有过ST段抬高型心肌梗死病史，中位年龄67岁，24%为女性，67%为白种人，55%有≥2个其他符合条件的危险因素，14%为当前吸烟者，67%超重/肥胖，34%血压≥140/90mmHg。81%因首次心肌梗死接受了经皮冠状动脉介入治疗（PCI；66%使用药物洗脱支架）。75%的患者出院时接受双联抗血小板治疗（DAPT；阿司匹林[ASA]+ADP受体抑制剂[ADPri]），主要是氯吡格雷（75%）。63%的患者在大约1年时停用了抗血小板治疗（60%停用ADP受体抑制剂），最常见的是根据医生建议（90%）。在入组时，97%的患者正在服用抗栓药物，最常见的是阿司匹林（88%），27%接受双联抗血小板治疗（中位持续时间1.6年）；双联抗血小板治疗持续>1年的比例在亚太地区最高（39%），在欧洲最低（12%）。
尽管有指南推荐，但四分之一的心肌梗死后患者在约1年时间内未接受双联抗血小板治疗。与支持使用更新的ADP受体抑制剂的指南推荐相反，氯吡格雷是主要的处方药物。在最近支持心肌梗死/经皮冠状动脉介入治疗后双联抗血小板治疗>1年的随机对照试验数据之前，四分之一以上的患者持续接受双联抗血小板治疗，尽管存在显著的国际差异。
