Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China; Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, China.
Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China.
Clin Ther. 2019 Apr;41(4):754-765. doi: 10.1016/j.clinthera.2019.03.001. Epub 2019 Mar 29.
Coronary artery disease is the top cause of death among the Chinese population. With the establishment of a Chinese prediction model, it is urgent to assess factors related to the prognosis of patients with acute coronary syndrome at extremely high risk.
In this retrospective study, we enrolled 601 patients assessed as being of extremely high risk, according to specific criteria from the China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk) project, and investigated various clinical parameters using Cox multivariate analysis to establish a risk nomogram. C-index and calibration curves were involved to assess the internal identification. By using the all-cause death risk model, we stratified patients by risk level and compared the effects of clopidogrel and ticagrelor on end points.
We identified several factors, including body mass index, angiopathy, smoking status, β-blocker usage, history of myocardial infarction, total number of stents, and usage of antiplatelet agents, related to ischemic end points, all-cause death, cardiovascular events, and cardiac death. A C-index of >0.7 and the calibration curve demonstrated good concordance. In a subsequent analysis, we used the all-cause death model to stratify patients by risk level, and compared the effects of clopidogrel and ticagrelor. In the subgroup with a 2-year death rate of >50%, ticagrelor showed a positive effect (P = 0.045), but in the subgroup with a 2-year death rate of <50%, the difference between clopidogrel and ticagrelor was not significant. Considering the duration of effect of antiplatelet agents, we also compared these 2 agents at 1-year follow up, with ticagrelor showing no advantage.
We determined the probability of ischemic risk in patients at extremely high ischemic risk and developed new risk models for this specific group. Ticagrelor, compared with clopidogrel, may improve the prognosis of patients at high risk for death after 2 years.
冠心病是中国人群的首要死因。随着中国预测模型的建立，迫切需要评估急性冠状动脉综合征极高危患者的预后相关因素。
在这项回顾性研究中，我们根据中国动脉粥样硬化性心血管疾病风险预测（China-PAR）项目的具体标准，纳入了 601 名被评估为极高危的患者，并使用 Cox 多因素分析调查了各种临床参数，以建立风险列线图。C 指数和校准曲线用于评估内部识别。通过使用全因死亡风险模型，我们根据风险水平对患者进行分层，并比较氯吡格雷和替格瑞洛对终点的影响。
我们确定了几个与缺血终点、全因死亡、心血管事件和心脏死亡相关的因素，包括体重指数、血管病变、吸烟状况、β受体阻滞剂使用、心肌梗死史、支架总数和抗血小板药物使用。C 指数>0.7，校准曲线显示良好的一致性。在随后的分析中，我们使用全因死亡模型根据风险水平对患者进行分层，并比较氯吡格雷和替格瑞洛的效果。在 2 年死亡率>50%的亚组中，替格瑞洛显示出积极的效果（P=0.045），但在 2 年死亡率<50%的亚组中，氯吡格雷和替格瑞洛之间的差异没有统计学意义。考虑到抗血小板药物的作用持续时间，我们还在 1 年随访时比较了这两种药物，替格瑞洛没有优势。
我们确定了极高缺血风险患者的缺血风险概率，并为这一特定人群开发了新的风险模型。替格瑞洛与氯吡格雷相比，可能改善 2 年后死亡风险较高患者的预后。
