既往急性冠脉综合征高危患者二级预防中的抗栓策略：大型多中心注册研究中PEGASUS研究入选标准与COMPASS研究入选标准的重叠情况

Antithrombotic Strategy in Secondary Prevention for High-Risk Patients with Previous Acute Coronary Syndrome: Overlap between the PEGASUS Eligibility and the COMPASS Eligibility in a Large Multicenter Registry.

作者信息

Millesimo Michele, Elia Edoardo, Marengo Giorgio, De Filippo Ovidio, Raposeiras-Roubin Sergio, Wańha Wojciech, Abu-Assi Emad, Kinnaird Tim, Ariza-Solé Albert, Liebetrau Christoph, Manzano-Fernández Sergio, Iannaccone Mario, Henriques Jose Paulo Simao, Templin Christian, Wilton Stephen B, Velicki Lazar, Xanthopoulou Ioanna, Correia Luis, Cerrato Enrico, Rognoni Andrea, Nuñez-Gil Iván, Song Xiantao, Kawaji Tetsuma, Quadri Giorgio, Huczek Zenon, Paz Rafael Cobas, Juanatey José Ramón González, Nie Shao-Ping, Kawashiri Masa-Aki, Dominguez-Rodriguez Alberto, Conrotto Federico, D'Ascenzo Fabrizio, De Ferrari Gaetano Maria

机构信息

Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy.

Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain.

出版信息

Am J Cardiovasc Drugs. 2023 Jan;23(1):77-87. doi: 10.1007/s40256-022-00554-5. Epub 2022 Oct 31.

DOI:10.1007/s40256-022-00554-5

PMID:36316613

Abstract

BACKGROUND

Patients with previous acute coronary syndrome (ACS) are at high risk of recurrent adverse cardiovascular events. Recently, prolonged dual antiplatelet therapy (DAPT) and oral anticoagulation therapy (OAT) have been shown to reduce recurrent ischemic events to the expense of an increase in bleeding events. The number of patients potentially eligible for these therapies in real life remains to be determined.

METHODS

Among ACS patients from five registries and one randomized controlled trial, we assessed the proportion of patients eligible for the PEGASUS strategy only and the proportion of patients eligible for the COMPASS strategy only, and set out the proportion of patients with an overlap between the strategies.

FINDINGS

Among the 10,048 evaluable patients, we found that 5373 (53.4%) were eligible for the PEGASUS strategy and 3841 (38.2%) were eligible for the COMPASS strategy, with a group of 3444 (34.4%) overlapping between the two strategies. The number of patients eligible for the PEGASUS strategy only was 1929 (19.2%) and the number eligible for the COMPASS strategy only was 397 (4.0%); 4278 (42.6%) were eligible for neither a PEGASUS strategy nor a COMPASS strategy.

INTERPRETATION

In a large cohort of ACS patients, one in three patients was eligible for either a prolonged DAPT with ticagrelor 60 mg and low-dose aspirin or a dual pathway inhibition approach with rivaroxaban 2.5 mg and low-dose aspirin.

摘要

背景

既往有急性冠状动脉综合征（ACS）的患者发生心血管不良事件复发的风险很高。最近的研究表明，延长双联抗血小板治疗（DAPT）和口服抗凝治疗（OAT）虽能减少缺血事件复发，但会增加出血事件的发生。在现实生活中，可能适合这些治疗的患者数量仍有待确定。

方法

在来自五个登记处和一项随机对照试验的ACS患者中，我们评估了仅符合PEGASUS策略的患者比例和仅符合COMPASS策略的患者比例，并列出了两种策略重叠的患者比例。

结果

在10048例可评估患者中，我们发现5373例（53.4%）符合PEGASUS策略，3841例（38.2%）符合COMPASS策略，其中3444例（34.4%）在两种策略之间存在重叠。仅符合PEGASUS策略的患者有1929例（19.2%），仅符合COMPASS策略的患者有397例（4.0%）；4278例（42.6%）既不符合PEGASUS策略也不符合COMPASS策略。