Jang Ho-Jun, Park Sang-Don, Park Hyun Woo, Suh Jon, Oh Pyung Chun, Moon Jeonggeun, Lee Kyounghoon, Kang Woong Chol, Kwon Sung Woo, Kim Tae-Hoon
Division of Cardiology, Sejong General Hospital, 28 Hohyeon-ro, 489beon-gil, Bucheon, Gyeongi-do, 14754, Republic of Korea.
Department of Cardiology, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea.
Drugs Aging. 2017 Jun;34(6):467-477. doi: 10.1007/s40266-017-0463-9.
Compared with dual antiplatelet therapy including aspirin and clopidogrel, triple antiplatelet therapy including cilostazol has a mortality benefit in patients with ST-segment elevation myocardial infarction. However, whether the mortality benefit persists in elderly patients is not clear.
From 2007 to 2014, 1278 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were retrospectively analyzed. The patients were divided into four groups by age (<75 or ≥75 years; young and elderly, respectively) and antiplatelet strategy (triple or dual antiplatelet therapy). We compared the mortality rates between the triple and dual antiplatelet therapy groups.
There were 1052 (male, 85%; mean age, 56.3 ± 10.4 years) patients in the young group and 241 (male, 52.7%; mean age, 80.3 ± 4.5 years) patients in the elderly group. In the young and elderly groups, 220 (20.9%) and 28 (12.3%) patients were treated with triple antiplatelet therapy. During a 1-year follow-up period, 80 patients died (4.2% in the young group vs. 15.5% in the elderly group). Kaplan-Meier survival analysis revealed that triple antiplatelet therapy was associated with a lower mortality rate in the young group (log-rank, p = 0.005). Although there were more angiographic high-risk patients in the elderly group, similar mortality rates were reported (log-rank, p = 0.803) without increased bleeding rates (1 vs. 3.6% in the elderly group, p = 0.217).
Triple antiplatelet therapy might be a better antiplatelet regimen than dual antiplatelet therapy for patients with ST-segment elevation myocardial infarction. Although this benefit was strong in patients aged <75 years, no definite increase in major bleeding was seen for elderly patients (aged ≥75 years).
与包括阿司匹林和氯吡格雷的双联抗血小板治疗相比，包括西洛他唑的三联抗血小板治疗对ST段抬高型心肌梗死患者有降低死亡率的益处。然而，这种死亡率益处是否在老年患者中持续存在尚不清楚。
对2007年至2014年期间1278例行直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者进行回顾性分析。根据年龄（<75岁或≥75岁；分别为年轻和老年）和抗血小板策略（三联或双联抗血小板治疗）将患者分为四组。我们比较了三联和双联抗血小板治疗组之间的死亡率。
年轻组有1052例患者（男性，85%；平均年龄，56.3±10.4岁），老年组有241例患者（男性，52.7%；平均年龄，80.3±4.5岁）。在年轻组和老年组中，分别有220例（20.9%）和28例（12.3%）患者接受了三联抗血小板治疗。在1年的随访期内，80例患者死亡（年轻组为4.2%，老年组为15.5%）。Kaplan-Meier生存分析显示，三联抗血小板治疗与年轻组较低的死亡率相关（对数秩检验，p=0.005）。虽然老年组血管造影高危患者更多，但报告的死亡率相似（对数秩检验，p=0.803），且出血率没有增加（老年组为1%对3.6%，p=0.217）。
对于ST段抬高型心肌梗死患者，三联抗血小板治疗可能是比双联抗血小板治疗更好的抗血小板方案。虽然这种益处在<75岁的患者中很明显，但老年患者（≥75岁）未观察到主要出血有明确增加。
