Choi Jae Hyuk, Cho Jung Rae, Park Sang Min, Shaha Kunal Bikram, Pierres Floyd, Sumiya Tserendavaa, Chun Kwang Jin, Kang Min Kyung, Choi Seonghoon, Lee Namho
Division of Cardiology, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Yonsei Med J. 2017 Sep;58(5):959-967. doi: 10.3349/ymj.2017.58.5.959.
The purpose of this study was to assess the potential benefit of a 5-hydroxytryptamine receptor antagonist, sarpogrelate-based triple antiplatelet therapy (TAPT) in comparison with dual antiplatelet therapy (DAPT) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
119 patients of STEMI were retrospectively assessed. All patients received aspirin and clopidogrel per standard of care. Among them, 53 patients received an additional loading dose of sarpogrelate and a maintenance dose for 6 months post-PCI (TAPT group), while others did not (DAPT group).
The rates of complete ST-segment resolution at 30 minutes post-PCI and post-procedural thrombolysis in myocardial infarction flow were not significantly different between the two groups (52.8% vs. 48.5%, p=0.200; 92.5% vs. 89.4%, p=0.080). In addition, no significant differences were observed between the two groups with regard to 30-day and 12-month clinical outcomes (cardiac death, myocardial infarction, stent thrombosis, target vessel revascularization, and severe bleeding). Meanwhile, improvement in left ventricular (LV) systolic function was observed in the TAPT group [ΔLV ejection fraction (LVEF)=17.1±9.4%, p<0.001; Δglobal longitudinal strain (GLS)=-9.4±4.2% , p<0.001] at 6 months, whereas it was not in the DAPT group (ΔLVEF= 8.8±6.5%, p=0.090; ΔGLS=-4.6±3.4%, p=0.106). In multivariate analyses, TAPT was an independent predictor for LV functional recovery (odds ratio, 2.61; 95% confidence interval, 1.16-5.87; p=0.003).
Sarpogrelate-based TAPT improved LV systolic function at 6 months in STEMI patients undergoing primary PCI.
本研究旨在评估5-羟色胺受体拮抗剂沙格雷酯为基础的三联抗血小板治疗（TAPT）相较于双联抗血小板治疗（DAPT），在接受ST段抬高型心肌梗死（STEMI）直接经皮冠状动脉介入治疗（PCI）患者中的潜在获益。
对119例STEMI患者进行回顾性评估。所有患者均按照标准治疗方案接受阿司匹林和氯吡格雷治疗。其中，53例患者在PCI术后额外接受了沙格雷酯负荷剂量及维持剂量治疗6个月（TAPT组），其余患者未接受（DAPT组）。
两组患者PCI术后30分钟时ST段完全回落率及术后心肌梗死溶栓血流分级无显著差异（52.8%对48.5%，p = 0.200；92.5%对89.4%，p = 0.080）。此外，两组在30天和12个月临床结局（心源性死亡、心肌梗死、支架血栓形成、靶血管血运重建及严重出血）方面未观察到显著差异。同时，TAPT组在6个月时观察到左心室（LV）收缩功能改善[左心室射血分数（LVEF）变化=17.1±9.4%，p<0.001；整体纵向应变（GLS）变化=-9.4±4.2%，p<0.001]，而DAPT组未观察到（LVEF变化= 8.8±6.5%，p = 0.090；GLS变化=-4.6±3.4%，p = 0.106）。在多因素分析中，TAPT是LV功能恢复的独立预测因素（比值比，2.61；95%置信区间，1.16 - 5.87；p = 0.003）。
在接受直接PCI的STEMI患者中，以沙格雷酯为基础的TAPT在6个月时改善了LV收缩功能。
