慢性冠状动脉综合征患者个体化抗血小板治疗后的年龄和结局：随机 PATH-PCI 试验的事后分析。
Age and outcomes following personalized antiplatelet therapy in chronic coronary syndrome patients: a post hoc analysis of the randomized PATH-PCI trial.
机构信息
Department of Cardiology, Xinjiang Medical University Affiliated First Hospital, Urumqi, China.
出版信息
Platelets. 2023 Dec;34(1):2206915. doi: 10.1080/09537104.2023.2206915.
It is particularly important to establish more effective and safer antiplatelet treatment strategies according to age. The present subanalysis of the PATH-PCI trial was to determine the safety and efficacy of any dual-antiplatelet therapy (DAPT) strategy in different age groups. We randomized 2285 chronic coronary syndrome (CCS) patients undergoing percutaneous coronary intervention (PCI) into a standard group or a personalized group from December 2016 to February 2018. The personalized group received personalized antiplatelet therapy (PAT) based on a novel platelet function test (PFT). The standard group received standard antiplatelet therapy (SAT). Then, all patients were divided according to age (under the age of 65 years and aged 65 years or over) to investigate the association and interaction of age on clinical outcomes at 180 days. In the patients under the age of 65 years, the incidence of NACEs was decreased in the personalized group compared to the standard group (5.1% vs. 8.8%, HR: 0.603, 95% CI: 0.409-0.888, = .010). The rates of MACCEs (3.3% vs. 7.7%, HR: 0.450, 95% CI: 0.285-0.712, = .001), MACEs (2.2% vs. 5.4%, HR: 0.423, 95% CI: 0.243-0.738, = .002) also decreased. We did not find a significant difference in bleeding between the groups. In the patients aged 65 years or over, no difference in the primary endpoint was found (4.9% vs. 4.2%, = .702), and comparable rates of survival were observed with the two strategies (all Ps > 0.05). The present study shows that PAT according to PFT was comparable to SAT at the 180-day follow-up for both ischemic and bleeding endpoints in CCS patients aged 65 years or over who underwent PCI. In patients under the age of 65 years, PAT can reduce ischemic events but does not increase bleeding, and it is an effective and safe treatment strategy. It may be necessary for young CCS patients after PCI to undergo PAT early after PCI.
根据年龄制定更有效和更安全的抗血小板治疗策略尤为重要。本研究旨在探讨不同年龄组中任何双联抗血小板治疗（DAPT）策略的安全性和疗效。我们于 2016 年 12 月至 2018 年 2 月期间，将 2285 例接受经皮冠状动脉介入治疗（PCI）的慢性冠状动脉综合征（CCS）患者随机分为标准组或个体化组。个体化组根据新型血小板功能试验（PFT）接受个体化抗血小板治疗（PAT）。标准组接受标准抗血小板治疗（SAT）。然后，根据年龄（<65 岁和≥65 岁）将所有患者分为两组，以研究年龄对 180 天临床结局的关联和交互作用。在<65 岁的患者中，与标准组相比，个体化组的 NACEs 发生率降低（5.1% vs. 8.8%，HR：0.603，95%CI：0.409-0.888，P=0.010）。MACCEs（3.3% vs. 7.7%，HR：0.450，95%CI：0.285-0.712，P=0.001）和 MACEs（2.2% vs. 5.4%，HR：0.423，95%CI：0.243-0.738，P=0.002）发生率也降低。两组间出血发生率无显著差异。在≥65 岁的患者中，主要终点无差异（4.9% vs. 4.2%，P=0.702），两种策略的存活率相当（所有 P 值均>0.05）。本研究表明，在接受 PCI 的≥65 岁 CCS 患者中，基于 PFT 的 PAT 在 180 天随访时，在缺血和出血终点方面与 SAT 相当。在<65 岁的患者中，PAT 可减少缺血事件但不会增加出血，是一种有效且安全的治疗策略。对于年轻的 CCS 患者，在 PCI 后可能需要尽早进行 PAT。
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