Oh Seok, Jeong Myung Ho, Cho Kyung Hoon, Kim Min Chul, Sim Doo Sun, Hong Young Joon, Kim Ju Han, Ahn Youngkeun
Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea.
Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea.
Front Cardiovasc Med. 2022 Sep 14;9:921955. doi: 10.3389/fcvm.2022.921955. eCollection 2022.
Antiplatelet therapy is crucial for managing acute myocardial infarction (AMI) and reducing adverse ischemic events after percutaneous coronary intervention (PCI) with drug-eluting stents. However, the ideal P2Y12 inhibitor for patients-particularly East Asians-with AMI and low platelet levels remains unknown. We evaluated the impact of various potencies of P2Y12 receptors on major cardiovascular outcomes of AMI patients with thrombocytopenia in Korea.
We analyzed the clinical and outcome data of 800 AMI patients with baseline platelet counts <150 × 10/μL who underwent PCI between November 2011 and June 2015. All patient data were obtained from the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry. Subjects were allocated to group A ( = 244; treated with potent P2Y12 inhibitors) or group B ( = 556; treated with clopidogrel). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs).
At the 3-year follow-up, clinical outcomes appeared better in group A than in Group B. However, after propensity score weighting-adjusted analysis, these findings were statistically attenuated, showing a similar incidence of MACCEs between the two groups.
Clopidogrel may be reasonable for patients with low platelet counts and is associated with comparable outcomes to potent P2Y12 inhibitors for Korean AMI patients.
抗血小板治疗对于急性心肌梗死（AMI）的管理以及降低药物洗脱支架经皮冠状动脉介入治疗（PCI）后的不良缺血事件至关重要。然而，对于AMI患者尤其是东亚患者且血小板水平较低时，理想的P2Y12抑制剂仍不明确。我们评估了不同效力的P2Y12受体对韩国血小板减少的AMI患者主要心血管结局的影响。
我们分析了2011年11月至2015年6月期间接受PCI的800例基线血小板计数<150×10⁹/μL的AMI患者的临床和结局数据。所有患者数据均来自韩国急性心肌梗死注册中心 - 美国国立卫生研究院注册库。受试者被分配到A组（n = 244；接受强效P2Y12抑制剂治疗）或B组（n = 556；接受氯吡格雷治疗）。主要终点是主要不良心脑血管事件（MACCEs）。
在3年随访时，A组的临床结局似乎优于B组。然而，经过倾向评分加权调整分析后，这些结果在统计学上有所减弱，两组之间MACCEs的发生率相似。
对于血小板计数低的患者，氯吡格雷可能是合理的，并且对于韩国AMI患者，其结局与强效P2Y12抑制剂相当。
