经皮冠状动脉介入治疗的急性冠状动脉综合征患者在导管室中的抗血栓策略：来自意大利心脏护理单位住院的急性冠状动脉综合征患者中使用的抗血栓治疗的见解登记处。

Antithrombotic strategies in the catheterization laboratory for patients with acute coronary syndromes undergoing percutaneous coronary interventions: insights from the EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units Registry.

机构信息

aDivision of Cardiology, San Giovanni Evangelista Hospital, Rome bUSC Cardiologia, Ospedale Santa Croce e Carle, Cuneo cDivision of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia dANMCO Research Center, Florence eDivision of Cardiology, Santa Maria della Misericordia Hospital, Perugia fDivision of Cardiology, Azienda Ospedaliera Specialistica dei Colli - Monaldi gDivision of Cardiology, Ospedale Cardarelli, Napoli hDivision of Cardiology, Azienda Ospedaliera Universitaria di Padova, Padova iDivision of Cardiology, IRCCS Multimedica, Sesto San Giovanni, Milano, Italy.

出版信息

J Cardiovasc Med (Hagerstown). 2017 Aug;18(8):580-589. doi: 10.2459/JCM.0000000000000533.

DOI:10.2459/JCM.0000000000000533

PMID:28639987

Abstract

AIMS

In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI).

METHODS

EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy.

RESULTS

Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7%) and non-ST-elevation ACS (77.5%) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0% of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7% of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure.

CONCLUSION

In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02015624.

摘要

目的

在过去的几十年中，出现了几种新的治疗方法来治疗急性冠状动脉综合征（ACS）。我们旨在描述接受经皮冠状动脉介入治疗（PCI）的 ACS 患者在导管室中使用抗血栓治疗的真实世界模式。

方法

在意大利心脏护理单位住院的急性冠状动脉综合征患者中使用的抗血栓治疗是一项全国性、前瞻性登记研究，旨在评估意大利 ACS 患者中使用的抗血栓策略。

结果

在 3 周的时间内，共有 2585 名连续 ACS 患者在意大利的 203 个心脏护理单位接受了治疗。在这些患者中，1755 名接受了 PCI（923 名 ST 段抬高型心肌梗死和 832 名非 ST 段抬高型 ACS）。在导管室中，未分馏肝素是接受 PCI 的 ST 段抬高型心肌梗死（64.7%）和非 ST 段抬高型 ACS（77.5%）中最常用的抗血栓药物，与术后相比，在 PCI 前或期间更常使用阿司匹林、比伐卢定和糖蛋白 IIb/IIIa 抑制剂（GPIs）。在 36.0%的情况下发生肝素治疗的交叉，而在 3.7%的患者中从一种 P2Y12 抑制剂转换为另一种抑制剂。多变量分析得出了导管室中使用 GPIs 和比伐卢定的几个独立预测因素，主要与临床表现、PCI 复杂性和手术期间的并发症有关。