Department of Pharmacy, Beijing Anzhen Hospital, Beijing, China.
School of Pharmaceutical Sciences, Capital Medical University, Beijing, China.
Glob Heart. 2023 Mar 13;18(1):11. doi: 10.5334/gh.1185. eCollection 2023.
It remains controversial whether to extend the course of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). We conducted a study to investigate the benefits and risks of applying DAPT for different durations after PCI in acute coronary syndromes (ACS) patients in China. What's more, we explored the efficacy of extended DAPT regimen based on ticagrelor.
This single-center prospective cohort study used data obtained from the PHARM-ACS Patient Registration Database. We included all patients who were discharged between April and December 2018. All patients had at least 18 months of follow-up. Patients were divided into two groups according to the duration of DAPT: a 1-year group and a >1-year group. Potential bias between the two groups was adjusted for by propensity score matching using logistic regression. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of death, myocardial infarction, and stroke occurring from 12 months after discharge to follow-up visit. The safety endpoint was any significant bleeding event (BARC ≥ 2).
Of 3,205 patients enrolled, 2,201 (68.67%) had DAPT prolonged beyond one year. A total of 2,000 patients were successfully propensity score-matched; patients who received DAPT > 1-year (n = 1000), compared with DAPT = 1-year patients (n = 1000), had a similar risk of MACCE (adjusted HR 0.23, 95% CI 0.05-1.10) and significant bleeding events (adjusted HR 0.63, 95% CI 0.32-1.24). The DAPT > 1-year group had a higher risk of revascularization (adjusted HR 3.36, 95% CI 1.64-6.87).
Prolonged DAPT may not be of sufficient benefit to ACS patients within 12-18 months after the index PCI to offset the increased risk of significant bleeding events.
经皮冠状动脉介入治疗（PCI）后延长双联抗血小板治疗（DAPT）疗程仍存在争议。我们进行了一项研究，以调查在中国急性冠脉综合征（ACS）患者中，不同时间长度的 DAPT 应用的获益和风险。此外，我们还探讨了基于替格瑞洛的延长 DAPT 方案的疗效。
这项单中心前瞻性队列研究使用了 PHARM-ACS 患者注册数据库获得的数据。我们纳入了 2018 年 4 月至 12 月出院的所有患者。所有患者均有至少 18 个月的随访。根据 DAPT 的持续时间，将患者分为两组：1 年组和>1 年组。使用 logistic 回归进行倾向评分匹配，以调整两组之间的潜在偏倚。主要终点是主要不良心脑血管事件（MACCE），定义为从出院后 12 个月到随访期间发生的死亡、心肌梗死和卒中等复合事件。安全性终点是任何显著出血事件（BARC≥2）。
在纳入的 3205 例患者中，2201 例（68.67%）的 DAPT 持续时间超过 1 年。共有 2000 例患者成功进行了倾向评分匹配；与 DAPT=1 年的患者（n=1000）相比，接受 DAPT>1 年的患者（n=1000）的 MACCE 风险相似（调整 HR 0.23，95%CI 0.05-1.10）和显著出血事件风险（调整 HR 0.63，95%CI 0.32-1.24）。DAPT>1 年组的血运重建风险更高（调整 HR 3.36，95%CI 1.64-6.87）。
在索引 PCI 后 12-18 个月内，延长 DAPT 对 ACS 患者可能没有足够的获益，无法抵消显著出血事件风险增加的影响。
