心肌梗死后主动脉瓣狭窄患者双联抗血小板治疗的结局。
Outcomes associated with dual antiplatelet therapy after myocardial infarction in patients with aortic stenosis.
机构信息
Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Center for Primary Health Care Research, Lund University, Malmö, Sweden.
出版信息
Int J Cardiol. 2019 Apr 15;281:140-145. doi: 10.1016/j.ijcard.2019.01.063. Epub 2019 Jan 19.
BACKGROUND
Acquired loss of the largest von Willebrand factor multimers is a common hemostatic disturbance in patients with aortic valve stenosis (AS), resulting in impaired platelet adhesion and increased bleeding risk. AS is also associated with atherosclerosis and myocardial infarction (MI). Our aim was to study the clinical outcomes associated with AS in MI patients treated with dual antiplatelet therapy (DAPT) in a nationwide hospital-based register study.
METHODS
Based on nationwide hospital discharge registers from Sweden (2005-2010) and Denmark (2005-2015), we calculated 1-year incidence rates and hazard ratios of bleeding, recurrent MI, and all-cause mortality in MI patients with and without AS treated with DAPT. Results from both countries were also combined in a meta-analysis.
RESULTS
We included 50,460 MI patients from Sweden and 50,307 MI patients from Denmark, of which 3% had AS. The bleeding rates (per 100 person-years) in Sweden and Denmark were 3.2 and 3.3 among patients without AS vs. 9.2 and 8.3 among patients with AS. All-cause mortality rates were 7.1 vs. 28.7 in Sweden and 5.8 vs. 30.7 in Denmark among patients without and with AS, respectively. Patients with AS had an increased risk of bleeding, recurrent MI and all-cause mortality. Combined results from both countries were similar for bleeding (hazard ratio 1.59 [0.98-2.59]), recurrent MI (1.78 [1.25-2.54]), and all-cause mortality (1.76 [1.26-2.47]).
CONCLUSION
AS was associated with an increased risk of bleeding, recurrent MI and mortality after MI when treated with DAPT. Individualized selection of antiplatelet therapy may be warranted in this high-risk population.
背景
主动脉瓣狭窄（AS）患者中最大的 von Willebrand 因子多聚体获得性缺失是常见的止血障碍，导致血小板黏附受损和出血风险增加。AS 还与动脉粥样硬化和心肌梗死（MI）有关。我们的目的是在一项全国性基于医院的登记研究中，研究接受双联抗血小板治疗（DAPT）的 MI 患者中 AS 相关的临床结局。
方法
基于瑞典（2005-2010 年）和丹麦（2005-2015 年）的全国性医院出院登记数据，我们计算了 DAPT 治疗的伴有和不伴有 AS 的 MI 患者 1 年出血、复发性 MI 和全因死亡率的发生率和风险比。两国的结果也在荟萃分析中合并。
结果
我们纳入了来自瑞典的 50460 例 MI 患者和来自丹麦的 50307 例 MI 患者，其中 3%有 AS。瑞典和丹麦无 AS 患者的出血发生率（每 100 人年）分别为 3.2 和 3.3，而有 AS 患者的出血发生率分别为 9.2 和 8.3。瑞典和丹麦无 AS 患者的全因死亡率分别为 7.1%和 28.7%，而有 AS 患者的全因死亡率分别为 5.8%和 30.7%。AS 患者出血、复发性 MI 和全因死亡率的风险增加。两国的合并结果在出血（风险比 1.59 [0.98-2.59]）、复发性 MI（1.78 [1.25-2.54]）和全因死亡率（1.76 [1.26-2.47]）方面相似。
结论
在接受 DAPT 治疗后，AS 与 MI 后出血、复发性 MI 和死亡率增加相关。在这一高危人群中，可能需要个体化选择抗血小板治疗。
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