急性心肌梗死患者超过12个月的单药和双联抗血小板治疗对缺血风险的临床影响

Clinical Impact of Single and Dual Antiplatelet Therapy Beyond 12 Months on Ischemic Risk in Patients With Acute Myocardial Infarction.

作者信息

Roh Ji Woong, Bae SungA, Kim Yongcheol, Son Nak-Hoon, Cho Deok-Kyu, Kim Jung-Sun, Kim Byeong-Keuk, Choi Donghoon, Hong Myeong-Ki, Jeong Myung Ho, Jang Yangsoo

机构信息

Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital and Cardiovascular Center, Yonsei University College of Medicine, Yongin, South Korea.

Division of Biostatistics, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea.

出版信息

Front Cardiovasc Med. 2021 Nov 24;8:783344. doi: 10.3389/fcvm.2021.783344. eCollection 2021.

There is ongoing debate regarding the optimal antiplatelet strategy beyond 12 months in patients with acute myocardial infarction (AMI) who undergo successful percutaneous coronary intervention (PCI). This study therefore aimed to investigate the clinical outcomes of single (SAPT) vs. dual antiplatelet therapy (DAPT) beyond 12 months in patients with stable AMI and second-generation drug-eluting stent (DES) implantation. Of 13,104 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health database, we selected 4,604 patients who underwent PCI with second-generation DES and exhibited no adverse clinical events within 12 months; they were classified into SAPT (aspirin or clopidogrel) or DAPT (aspirin and clopidogrel) groups. The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE), including the composite of all-cause death, myocardial infarction (MI), and stroke between 12 and 36 months. The SAPT group ( = 1,862) was associated with a significantly lower risk of MACCE between 12 and 36 months [4.2 vs. 8.5%, hazard ratio (HR): 0.47, 95% confidence interval (CI): 0.37-0.61; < 0.001] than the DAPT group ( = 2,742). The results were consistent after adjusting for confounders through multivariable and propensity score matching analysis. Moreover, in patients with complex features (defined as an unprotected left main PCI, implanted stent length of ≥38 mm, multivessel PCI, or ≥3 stents per patients), the SAPT group ( = 678) also demonstrated a significantly lower risk of MACCE between 12 and 36 months (4.9 vs. 9.9%, HR: 0.46, CI: 0.31-0.68, < 0.001) than the DAPT group ( = 1,167). In patients with AMI who underwent successful PCI with second-generation DES and exhibited no adverse clinical events within 12 months, the use of SAPT was associated with a significantly lower MACCE between 12 and 36 months compared with the use of DAPT.

对于接受成功经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者，12个月后的最佳抗血小板策略仍存在争议。因此，本研究旨在调查稳定型AMI且植入第二代药物洗脱支架（DES）的患者在12个月后单药抗血小板治疗（SAPT）与双联抗血小板治疗（DAPT）的临床结局。在韩国急性心肌梗死注册研究-美国国立卫生研究院数据库的13104例患者中，我们选择了4604例接受第二代DES PCI且在12个月内未出现不良临床事件的患者；他们被分为SAPT组（阿司匹林或氯吡格雷）或DAPT组（阿司匹林和氯吡格雷）。主要终点是主要不良心脑血管事件（MACCE），包括12至36个月期间全因死亡、心肌梗死（MI）和中风的复合事件。与DAPT组（n = 2742）相比，SAPT组（n = 1862）在12至36个月期间MACCE风险显著更低[4.2%对8.5%，风险比（HR）：0.47，95%置信区间（CI）：0.37 - 0.61；P < 0.001]。通过多变量和倾向评分匹配分析调整混杂因素后，结果一致。此外，在具有复杂特征的患者（定义为无保护左主干PCI、植入支架长度≥38 mm、多支血管PCI或每位患者≥3个支架）中，SAPT组（n = 678）在12至36个月期间MACCE风险也显著低于DAPT组（n = 1167）（4.9%对9.9%，HR：0.46，CI：0.31 - 0.68，P < 0.001）。在接受第二代DES PCI且在12个月内未出现不良临床事件的AMI患者中，与使用DAPT相比，使用SAPT在12至36个月期间MACCE显著更低。