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静脉用抗凝治疗与未接受介入治疗的非 ST 段抬高型急性冠状动脉综合征患者结局的相关性:来自改善中国心血管疾病医疗质量(CCC)项目的研究结果。

Association of Parenteral Anticoagulation Therapy With Outcomes in Non-ST-Segment Elevation Acute Coronary Syndrome Patients Without Invasive Therapy: Findings from the Improving Care for Cardiovascular Disease in China (CCC) project.

机构信息

Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

Department of Cardiology, School of Medicine, South China University of Technology, Guangzhou, China.

出版信息

Clin Pharmacol Ther. 2021 Oct;110(4):1119-1126. doi: 10.1002/cpt.2370. Epub 2021 Aug 10.

Abstract

Our previous study showed that parenteral anticoagulation therapy (PACT) in the context of aggressive antiplatelet therapy failed to improve clinical outcomes in patients undergoing percutaneous coronary intervention for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). However, the role of PACT in patients managed medically remains unknown. This observational cohort study enrolled patients with NSTE-ACS receiving medical therapy from November 2014 to June 2017 in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project. Eligible patients were included in the PACT group and non-PACT group. The primary outcomes were in-hospital all-cause mortality and major bleeding. The secondary outcome included minor bleeding. Among 23,726 patients, 8,845 eligible patients who received medical therapy were enrolled. After adjusting the potential confounders, PACT was not associated with a lower risk of in-hospital all-cause mortality (adjusted odds ratio (OR), 1.25; 95% confidence interval (CI), 0.92-1.71; P = 0.151). Additionally, PACT did not increase the incidence of major bleeding or minor bleeding (major bleeding: adjusted OR, 1.04; 95% CI, 0.80-1.35; P = 0.763; minor bleeding: adjusted OR, 1.27; 95% CI, 0.91-1.75; P = 0.156). The propensity score analysis confirmed the primary analyses. In patients with NSTE-ACS receiving antiplatelet therapy, PACT was not associated with a lower risk of in-hospital all-cause mortality or a higher bleeding risk in patients with NSTE-ACS receiving non-invasive therapies and concurrent antiplatelet strategies. Randomized clinical trials are warranted to reevaluate the safety and efficacy of PACT in all patients with NSTE-ACS who receive noninvasive therapies and current antithrombotic strategies.

摘要

我们之前的研究表明,在强化抗血小板治疗的背景下,经皮冠状动脉介入治疗非 ST 段抬高型急性冠脉综合征(NSTE-ACS)患者中,静脉抗凝治疗(PACT)未能改善临床结局。然而,PACT 在接受药物治疗的患者中的作用尚不清楚。这项观察性队列研究纳入了 2014 年 11 月至 2017 年 6 月在中国改善心血管疾病治疗-急性冠脉综合征项目中接受药物治疗的 NSTE-ACS 患者。符合条件的患者被纳入 PACT 组和非 PACT 组。主要结局为住院全因死亡率和主要出血。次要结局包括轻微出血。在 23726 例患者中,纳入了 8845 例接受药物治疗的符合条件的患者。调整潜在混杂因素后,PACT 与住院全因死亡率降低无关(校正比值比(OR),1.25;95%置信区间(CI),0.92-1.71;P=0.151)。此外,PACT 并未增加主要出血或轻微出血的发生率(主要出血:校正 OR,1.04;95%CI,0.80-1.35;P=0.763;轻微出血:校正 OR,1.27;95%CI,0.91-1.75;P=0.156)。倾向评分分析证实了主要分析结果。在接受抗血小板治疗的 NSTE-ACS 患者中,PACT 与住院全因死亡率降低或接受非侵入性治疗和同时抗血小板策略的 NSTE-ACS 患者出血风险增加无关。需要进行随机临床试验来重新评估在接受非侵入性治疗和当前抗血栓形成策略的所有 NSTE-ACS 患者中 PACT 的安全性和疗效。

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