在中国，已经接受慢性 P2Y12 受体抑制剂治疗的非 ST 段抬高型急性冠脉综合征患者中，P2Y12 抑制剂再负荷与住院结局的关系：来自 CCC-ACS（改善中国心血管疾病治疗-急性冠脉综合征）项目的结果。
Association between P2Y12 inhibitor reloading and in-hospital outcomes for patients with non-ST-segment elevation acute coronary syndrome already on chronic P2Y12 receptor inhibitors therapy in China: findings from the CCC-ACS (improving care for cardiovascular disease in China-acute coronary syndrome) project.
机构信息
Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, People's Republic of China.
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
出版信息
Eur J Med Res. 2023 Feb 2;28(1):59. doi: 10.1186/s40001-023-01025-6.
BACKGROUND
The association between P2Y12 receptor inhibitors reloading and in-hospital outcomes in non-ST-segment elevation acute coronary syndrome (NSTEACS) patients who were on chronic P2Y12 receptor inhibitors therapy remained underdetermined.
METHODS
The Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS project) is a national registry active from November 2014 to December 2019. 4790 NSTEACS patients on chronic P2Y12 receptor inhibitors therapy were included. Cox proportional hazard models, Kaplan-Meier curves, and subgroup analyses were conducted.
RESULTS
The NSTEACS patients who received reloading of P2Y12 receptor inhibitors were younger and had fewer comorbid conditions. The reloading group had a lower risk of major adverse cardiac events (MACE) (0.51% vs. 1.43%, P = 0.007), and all-cause death (0.36% vs. 0.99%, P = 0.028), the risks of myocardial infarction and major bleeding were not significantly different between patients with and without reloading. In survival analysis, a lower cumulative risk of MACE could be identified (Log-rank test, P = 0.007) in reloading group. In the unadjusted Cox model, reloading P2Y12 receptor inhibitors was associated with a decreased risk of MACE [HR, 0.35; 95% CI 0.16-0.78; (P = 0.010)] and all-cause death [HR, 0.37; 95% CI 0.14-0.94; (P = 0.036)]. Reloading of P2Y12 receptor inhibitors was associated with a decreased risk of MACE in most of the subgroups.
CONCLUSIONS
In NSTEACS patients already taking P2Y12 receptor inhibitors, we observed a decreased risk of in-hospital MACEs and all-cause mortality and did not observe an increased risk of major bleeding, with reloading. The differential profile in the two groups might influence this association and further studies are warranted.
CLINICAL TRIAL REGISTRATION
CLINICALTRIALS
gov (Unique identifier: NCT02306616, date of first registration: 03/12/2014).
背景
在接受慢性 P2Y12 受体抑制剂治疗的非 ST 段抬高型急性冠状动脉综合征（NSTEACS）患者中，P2Y12 受体抑制剂再负荷与住院结局之间的关系仍未确定。
方法
改善中国心血管疾病治疗-急性冠状动脉综合征（CCC-ACS 项目）是一项全国性登记研究，从 2014 年 11 月至 2019 年 12 月开展。共纳入 4790 例接受慢性 P2Y12 受体抑制剂治疗的 NSTEACS 患者。采用 Cox 比例风险模型、Kaplan-Meier 曲线和亚组分析。
结果
接受 P2Y12 受体抑制剂再负荷的 NSTEACS 患者年龄较小，合并症较少。再负荷组主要不良心脏事件（MACE）发生率较低（0.51% vs. 1.43%，P=0.007），全因死亡率较低（0.36% vs. 0.99%，P=0.028），心肌梗死和大出血的发生率在再负荷组和无再负荷组之间无显著差异。生存分析显示，再负荷组 MACE 的累积风险较低（Log-rank 检验，P=0.007）。在未调整的 Cox 模型中，再负荷 P2Y12 受体抑制剂与 MACE 风险降低相关[风险比（HR），0.35；95%置信区间（CI）0.16-0.78；（P=0.010）]和全因死亡[HR，0.37；95%CI 0.14-0.94；（P=0.036）]。在大多数亚组中，再负荷 P2Y12 受体抑制剂与 MACE 风险降低相关。
结论
在已经接受 P2Y12 受体抑制剂治疗的 NSTEACS 患者中，我们观察到再负荷与住院期间 MACE 和全因死亡率降低相关，且未观察到大出血风险增加。两组之间的差异可能影响这种关联，需要进一步研究。
临床试验注册
临床试验.gov（唯一标识符：NCT02306616，首次注册日期：2014 年 3 月 12 日）。
Zotero 插件