药物洗脱支架植入术后延长双联抗血小板治疗可改善急性冠状动脉综合征的长期预后：一项大型队列研究的五年结果
Prolonged dual antiplatelet therapy after drug-eluting stent implantation improves long-term prognosis for acute coronary syndrome: five-year results from a large cohort study.
作者信息
Xu Jing-Jing, Jia Si-da, Jiang Lin, Song Ying, Zhu Pei, Yuan De-Shan, Yao Yi, Zhao Xue-Yan, Li Jian-Xin, Yang Yue-Jin, Qiao Shu-Bin, Xu Bo, Gao Run-Lin, Yuan Jin-Qing
机构信息
Department of Cardiology, Fuwai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
出版信息
World J Emerg Med. 2023;14(1):25-30. doi: 10.5847/wjem.j.1920-8642.2023.012.
BACKGROUND
To investigate the most appropriate dual antiplatelet therapy (DAPT) duration for patients with acute coronary syndrome (ACS) after drug-eluting stent (DES) implantation in the largest cardiovascular center of China.
METHODS
We enrolled 5,187 consecutive patients with ACS who received DES from January to December 2013. Patients were divided into four groups based on DAPT duration: standard DAPT group (11-13 months, =1,568) and prolonged DAPT groups (13-18 months [=308], 18-24 months [=2,125], and >24 months [=1,186]). Baseline characteristics and 5-year clinical outcomes were recorded.
RESULTS
Baseline characteristics were similar across the four groups. Among the four groups, those with prolonged DAPT (18-24 months) had the lowest incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) (14.1% vs. 11.7% vs. 9.6% vs. 24.2%, <0.001), all-cause death (4.8% vs. 3.9% vs. 2.1% vs. 2.6%, <0.001), cardiac death (3.1% vs. 2.6% vs. 1.4% vs. 1.9%, =0.004), and myocardial infarction (MI) (3.8% vs. 4.2% vs. 2.5% vs. 5.8%, <0.001). The incidence of bleeding was not different among the four groups (9.9% vs. 9.4% vs. 11.0% vs. 9.4%, =0.449). Cox multivariable analysis showed that prolonged DAPT (18-24 months) was an independent protective factor for MACCEs (hazard ratio [] 0.802, 95% confidence interval [] 0.729-0.882, <0.001), all-cause death ( 0.660, 95% 0.547-0.795, <0.001), cardiac death ( 0.663, 95% 0.526-0.835, <0.001), MI ( 0.796, 95% 0.662-0.957, =0.015), and target vessel revascularization ( 0.867, 95% 0.755-0.996, =0.044). Subgroup analysis for high bleeding risk showed that prolonged DAPT remained an independent protective factor for all-cause death and MACCEs.
CONCLUSION
For patients with ACS after DES, appropriately prolonging the DAPT duration may be associated with a reduced risk of adverse ischemic events without increasing the bleeding risk.
背景
在中国最大的心血管中心，研究药物洗脱支架（DES）植入术后急性冠状动脉综合征（ACS）患者最合适的双联抗血小板治疗（DAPT）时长。
方法
我们纳入了2013年1月至12月连续接受DES治疗的5187例ACS患者。根据DAPT时长将患者分为四组：标准DAPT组（11 - 13个月，n = 1568）和延长DAPT组（13 - 18个月[n = 308]、18 - 24个月[n = 2125]以及>24个月[n = 1186]）。记录基线特征和5年临床结局。
结果
四组的基线特征相似。在四组中，延长DAPT（18 - 24个月）组的主要不良心血管和脑血管事件（MACCEs）发生率最低（14.1%对11.7%对9.6%对24.2%，P<0.001）、全因死亡（4.8%对3.9%对2.1%对2.6%，P<0.001）、心源性死亡（3.1%对2.6%对1.4%对1.9%，P = 0.004）以及心肌梗死（MI）（3.8%对4.2%对2.5%对5.8%，P<0.001）。四组间出血发生率无差异（9.9%对9.4%对11.0%对9.4%，P = 0.449）。Cox多变量分析显示，延长DAPT（18 - 24个月）是MACCEs（风险比[HR]0.802，95%置信区间[CI]0.729 - 0.882，P<0.001）、全因死亡（HR 0.660，95%CI 0.547 - 0.795，P<0.001）、心源性死亡（HR 0.663，95%CI 0.526 - 0.835，P<0.001）、MI（HR 0.796，95%CI 0.662 - 0.957，P = 0.015）以及靶血管血运重建（HR 0.867，95%CI 0.755 - 0.996，P = 0.044）的独立保护因素。高出血风险亚组分析显示，延长DAPT仍然是全因死亡和MACCEs的独立保护因素。
结论
对于DES植入术后的ACS患者，适当延长DAPT时长可能在不增加出血风险的情况下降低不良缺血事件风险。
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