Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China.
Chin Med J (Engl). 2017 Oct 5;130(19):2321-2325. doi: 10.4103/0366-6999.215330.
Acute aortic dissection is known as the most dangerous aortic disease, with management and prognosis determined as the disruption of the medial layer provoked by intramural bleeding. The objective of this study was to evaluate the safety and necessity of antiplatelet therapy on patients with Stanford Type B aortic dissection (TBAD) who underwent endovascular aortic repair (EVAR).
The present study retrospectively analyzed 388 patients with TBAD who underwent EVAR and coronary angiography. The primary outcomes were hemorrhage, death, endoleak, recurrent dissection, myocardial infarction, and cerebral infarction in patients with and without aspirin antiplatelet therapy at 1 month and 12 months.
Of those 388 patients, 139 (35.8%) patients were treated with aspirin and 249 (64.2%) patients were not treated with aspirin. Patients in the aspirin group were elderly (57.0 ± 10.3 years vs. 52.5 ± 11.9 years, respectively, χ2 = 3.812, P < 0.001) and had more hypertension (92.1% vs. 83.9%, respectively, χ2 = 5.191, P = 0.023) and diabetes (7.2% vs. 2.8%, respectively, χ2 = 4.090, P = 0.043) than in the no-aspirin group. Twelve patients (aspirin group vs. no-aspirin group; 3.6% vs. 2.8%, respectively, χ2 = 0.184, P = 0.668) died at 1-month follow-up, while the number was 18 (4.6% vs. 5.0%, respectively, χ2 = 0.027, P = 0.870) at 12-month follow-up. Hemorrhage occurred in 1 patient (Bleeding Academic Research Consortium [BARC] Type 2) of the aspirin group, and 3 patients (1 BARC Type 2 and 2 BARC Type 5) in the no-aspirin group at 1-month follow-up (χ2 = 0.005, P = 0.944). New hemorrhage occurred in five patients in the no-aspirin group at 12-month follow-up. Three patients in the aspirin group while five patients in the no-aspirin group had recurrent dissection for endoleak at 1-month follow-up (2.3% vs. 2.2%, respectively, χ2 = 0.074, P = 0.816). Four patients had new dissection in the no-aspirin group at 12-month follow-up (2.3% vs. 3.8%, respectively, χ2 = 0.194, P = 0.660). Each group had one patient with myocardial infarction at 1-month follow-up (0.8% vs. 0.4%, respectively, χ2 = 0.102, P = 0.749) and one more patient in the no-aspirin group at 12-month follow-up. No one had cerebral infarction in both groups during the 12-month follow-up. In the percutaneous coronary intervention (PCI) subgroup, 44 (31.7%) patients had taken dual-antiplatelet therapy (DAPT, aspirin + clopidogrel) and the other 95 (68.3%) patients had taken only aspirin. There was no significant difference in hemorrhage (0% vs. 1.1%, respectively, χ2 = 0.144, P = 0.704), death (4.8% vs. 4.5%, respectively, χ2 = 0.154, P = 0.695), myocardial infarction (2.4% vs. 0%, respectively, χ2 = 0.144, P = 0.704), endoleak, and recurrent dissection (0% vs. 3.4%, respectively, χ2 = 0.344, P = 0.558) between the two groups at 12-month follow-up.
The present study indicated that long-term oral low-dose aspirin was safe for patients with both TBAD and coronary heart disease who underwent EVAR. For the patients who underwent both EVAR and PCI, DAPT also showed no increase in hemorrhage, endoleak, recurrent dissection, death, and myocardial infarction.
急性主动脉夹层是最危险的主动脉疾病之一，其发病机制被认为是中层的破裂和血液的进入。本研究旨在评估接受血管内修复（EVAR）的 Stanford B 型主动脉夹层（TBAD）患者抗血小板治疗的安全性和必要性。
本研究回顾性分析了 388 例接受 EVAR 和冠状动脉造影的 TBAD 患者。主要终点是在 1 个月和 12 个月时接受和不接受阿司匹林抗血小板治疗的患者的出血、死亡、内漏、复发性夹层、心肌梗死和脑梗死的发生率。
388 例患者中，139 例（35.8%）患者接受阿司匹林治疗，249 例（64.2%）患者未接受阿司匹林治疗。阿司匹林组患者年龄较大（57.0±10.3 岁 vs. 52.5±11.9 岁，χ2=3.812，P<0.001），且高血压（92.1% vs. 83.9%，χ2=5.191，P=0.023）和糖尿病（7.2% vs. 2.8%，χ2=4.090，P=0.043）的发生率更高。在 1 个月的随访中，12 例患者（阿司匹林组 vs. 非阿司匹林组；3.6% vs. 2.8%，χ2=0.184，P=0.668）死亡，而在 12 个月的随访中，18 例患者（4.6% vs. 5.0%，χ2=0.027，P=0.870）死亡。阿司匹林组有 1 例患者（BARC 2 型出血）在 1 个月的随访中出现出血，而非阿司匹林组有 3 例患者（1 例 BARC 2 型出血和 2 例 BARC 5 型出血）（χ2=0.005，P=0.944）。在 12 个月的随访中，非阿司匹林组有 5 例患者出现新的出血。阿司匹林组有 3 例患者（2.3%）和非阿司匹林组有 5 例患者（2.2%）（χ2=0.074，P=0.816）在 1 个月的随访中出现内漏复发性夹层。非阿司匹林组有 4 例患者（2.3%）在 12 个月的随访中出现新的夹层（χ2=0.194，P=0.660）。阿司匹林组和非阿司匹林组各有 1 例患者在 1 个月的随访中出现心肌梗死（0.8% vs. 0.4%，χ2=0.102，P=0.749），而非阿司匹林组在 12 个月的随访中出现 1 例患者。两组在 12 个月的随访中均无患者发生脑梗死。在经皮冠状动脉介入治疗（PCI）亚组中，44 例（31.7%）患者接受了双联抗血小板治疗（阿司匹林+氯吡格雷），95 例（68.3%）患者仅接受了阿司匹林治疗。两组在 12 个月的随访中，出血（0% vs. 1.1%，χ2=0.144，P=0.704）、死亡（4.8% vs. 4.5%，χ2=0.154，P=0.695）、心肌梗死（2.4% vs. 0%，χ2=0.144，P=0.704）、内漏和复发性夹层（0% vs. 3.4%，χ2=0.344，P=0.558）发生率无显著差异。
本研究表明，长期口服低剂量阿司匹林对接受 EVAR 的 TBAD 合并冠心病患者是安全的。对于同时接受 EVAR 和 PCI 的患者，DAPT 也不会增加出血、内漏、复发性夹层、死亡和心肌梗死的发生率。
