老年患者药物洗脱支架置入术后短期与长期双联抗血小板治疗的比较：6 项随机临床试验个体参与者数据的荟萃分析。
Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Elderly Patients: A Meta-Analysis of Individual Participant Data From 6 Randomized Trials.
机构信息
Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea.
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
出版信息
JACC Cardiovasc Interv. 2018 Mar 12;11(5):435-443. doi: 10.1016/j.jcin.2017.10.015. Epub 2018 Feb 14.
OBJECTIVES
This study sought to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after the implantation of a drug-eluting stent (DES) in elderly patients.
BACKGROUND
Qualified studies to evaluate the optimal duration of DAPT in elderly patients have been very limited.
METHODS
Using 6 randomized trials that compared short-term (≤6 months) and long-term (12 months) DAPT, individual participant data meta-analysis was performed in elderly patients (≥65 years of age). The primary study outcome was the 12-month risk of a composite of myocardial infarction, definite or probable stent thrombosis, or stroke. The major secondary outcome was the 12-month risk of major bleeding.
RESULTS
The primary outcome risk did not significantly differ between patients receiving short-term and long-term DAPT (hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.88 to 1.43; p = 0.3581) in the overall group of study participants. In subgroup analysis, a significant interaction between age and DAPT duration was observed for primary outcome risk (p for interaction = 0.0384). In the subset of younger patients (<65 years of age, n = 6,152), short-term DAPT was associated with higher risk of primary outcome (HR: 1.67; 95% CI: 1.14 to 2.44; p = 0.0082). In elderly patients (n = 5,319), however, the risk of primary outcome did not significantly differ between patients receiving short-term and long-term DAPT (HR: 0.84; 95% CI: 0.60 to 1.16; p = 0.2856). Short-term DAPT was associated with a significant reduction in major bleeding compared with long-term DAPT (HR: 0.50; 95% CI: 0.30 to 0.84; p = 0.0081) in the overall group, and particularly in elderly patients (HR: 0.46; 95% CI: 0.24-0.88; p = 0.0196).
CONCLUSIONS
Short-term DAPT after new-generation DES implantation may be more beneficial in elderly patients than in younger patients.
目的
本研究旨在评估老年患者植入药物洗脱支架（DES）后双联抗血小板治疗（DAPT）的最佳持续时间。
背景
评估老年患者 DAPT 最佳持续时间的合格研究非常有限。
方法
使用 6 项比较短期（≤6 个月）和长期（12 个月）DAPT 的随机试验，对老年患者（≥65 岁）进行个体参与者数据荟萃分析。主要研究结局为 12 个月时心肌梗死、明确或可能的支架血栓形成或卒中等复合终点的风险。主要次要结局为 12 个月时大出血的风险。
结果
在所有研究参与者中，接受短期和长期 DAPT 的患者主要结局风险无显著差异（风险比 [HR]：1.12；95%置信区间 [CI]：0.88 至 1.43；p=0.3581）。亚组分析显示，年龄与 DAPT 持续时间对主要结局风险存在显著交互作用（p 交互=0.0384）。在年龄较小的患者亚组（<65 岁，n=6152）中，短期 DAPT 与主要结局风险升高相关（HR：1.67；95%CI：1.14 至 2.44；p=0.0082）。然而，在老年患者（n=5319）中，接受短期和长期 DAPT 的患者主要结局风险无显著差异（HR：0.84；95%CI：0.60 至 1.16；p=0.2856）。与长期 DAPT 相比，短期 DAPT 可显著降低大出血风险（HR：0.50；95%CI：0.30 至 0.84；p=0.0081），这种差异在总体人群中存在，在老年患者中更明显（HR：0.46；95%CI：0.24 至 0.88；p=0.0196）。
结论
与年轻患者相比，在老年患者中，新一代 DES 植入术后短期 DAPT 可能更有益。
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