Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Unit of Research, Education and Development, Region jämtland Härjedalen, Östersund, Sweden.
BMC Cardiovasc Disord. 2019 Mar 4;19(1):51. doi: 10.1186/s12872-019-1030-6.
To evaluate the impact of a rapid change in preferred treatment from clopidogrel to ticagrelor on the risk of ischemic stroke following acute myocardial infarction (AMI).
Data for AMI patients treated with either clopidogrel or ticagrelor were obtained from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). Patients were divided into two cohorts, each covering a two-year time period; the initial prescription of ticagrelor (20 Dec 2011) was used as a cut-off point. Patients in the early cohort (n = 23,447) were treated with clopidogrel, while those in the later cohort (n = 24,227), were treated with either clopidogrel (47.9%) or ticagrelor (52.1%). Kaplan-Meier analyses were used to assess the risk of ischemic stroke over time, with multivariable Cox regression analyses used to identify predictors of ischemic stroke.
Of 47,674 patients, there were 1203 cases of ischemic stroke. Cumulative Kaplan-Meier incidence estimates of ischemic stroke after one year were 2.8% vs. 2.4% for the early and late cohorts, respectively (p = 0.001). Older age, hypertension, diabetes, previous stroke, congestive heart failure, atrial fibrillation, and ST-elevation myocardial infarction were associated with an increased risk of ischemic stroke. Percutaneous coronary intervention and statins at discharge were associated with a decreased risk of ischemic stroke, as was higher estimated glomerular filtration rate. Membership of the late cohort correlated with a 13% reduction in the relative risk of ischemic stroke.
The introduction of ticagrelor as well as an improved management of AMI was associated with a lower rate of ischemic stroke in a relatively unselected AMI population.
评估急性心肌梗死（AMI）后，从氯吡格雷转为替格瑞洛的首选治疗方案快速改变对缺血性卒中风险的影响。
从瑞典信息和知识登记关于瑞典心脏重症监护入院（RIKS-HIA）中获取接受氯吡格雷或替格瑞洛治疗的 AMI 患者数据。将患者分为两个队列，每个队列覆盖两年时间；替格瑞洛的初始处方（2011 年 12 月 20 日）作为截止点。早期队列（n=23447）患者接受氯吡格雷治疗，而晚期队列（n=24227）患者接受氯吡格雷（47.9%）或替格瑞洛（52.1%）治疗。采用 Kaplan-Meier 分析评估随时间推移的缺血性卒中风险，采用多变量 Cox 回归分析确定缺血性卒中的预测因素。
在 47674 例患者中，有 1203 例发生缺血性卒中。一年后缺血性卒中的累积 Kaplan-Meier 发生率分别为早期和晚期队列的 2.8%和 2.4%（p<0.001）。年龄较大、高血压、糖尿病、既往卒中、充血性心力衰竭、心房颤动和 ST 段抬高型心肌梗死与缺血性卒中风险增加相关。出院时经皮冠状动脉介入治疗和他汀类药物与缺血性卒中风险降低相关，估算肾小球滤过率较高也与缺血性卒中风险降低相关。晚期队列的成员与缺血性卒中相对风险降低 13%相关。
替格瑞洛的引入以及 AMI 的治疗管理改善与相对未选择的 AMI 人群中缺血性卒中发生率降低相关。
