Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France.
Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France.
JACC Cardiovasc Interv. 2024 Feb 12;17(3):359-370. doi: 10.1016/j.jcin.2023.12.011.
Whether ticagrelor in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) can prevent cardiovascular events is unknown.
The authors sought to evaluate outcomes of complex PCI and the efficacy of ticagrelor vs clopidogrel in stable patients randomized in the ALPHEUS (Assessment of Loading with the P2Y inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting) trial.
All PCI procedures were blindly reviewed and classified as complex if they had at least 1 of the following criteria: stent length >60 mm, 2-stent bifurcation, left main, bypass graft, chronic total occlusion, use of atherectomy or guiding catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b myocardial infarction (MI) and major myocardial injury during the 48 hours after PCI. We compared the event rates according to the presence or not of complex PCI criteria and evaluated the interaction with ticagrelor or clopidogrel.
Among the 1,866 patients randomized, 910 PCI (48.3%) were classified as complex PCI. The primary endpoint was more frequent in complex PCI (45.6% vs 26.6%; P < 0.001) driven by higher rates of type 4 MI and angiographic complications (12.2% vs 4.8 %; P < 0.001 and 19.3% vs 8.6%; P < 0.05, respectively). The composite of death, MI, and stroke at 48 hours (12.7% vs 5.1 %; P < 0.05) and at 30 days (13.4% vs 5.3%; P < 0.05) was more frequent in complex PCI. No interaction was found between PCI complexity and the randomized treatment for the primary endpoint (P = 0.47) nor the secondary endpoints.
In chronic coronary syndrome, patients undergoing a complex PCI have higher rates of periprocedural and cardiovascular events that are not reduced by ticagrelor as compared with clopidogrel.
在接受复杂经皮冠状动脉介入治疗（PCI）的慢性冠状动脉综合征患者中，替格瑞洛能否预防心血管事件尚不清楚。
作者旨在评估复杂 PCI 的结果，并评估在 ALPHEUS（评估在择期冠状动脉支架置入术患者中使用 P2Y 抑制剂替格瑞洛或氯吡格雷负荷剂量以停止缺血性事件）试验中随机分组的稳定患者中替格瑞洛与氯吡格雷的疗效。
所有 PCI 手术均由盲法审查，并根据以下至少 1 项标准将其分类为复杂手术：支架长度>60mm、双支架分叉、左主干、旁路移植、慢性完全闭塞、使用旋磨术或引导导管延长、多导丝技术、多个支架。主要终点是 PCI 后 48 小时内 4a 或 4b 型心肌梗死（MI）和主要心肌损伤的复合终点。我们根据是否存在复杂 PCI 标准比较了事件发生率，并评估了与替格瑞洛或氯吡格雷的相互作用。
在 1866 例随机患者中，910 例（48.3%）的 PCI 被归类为复杂 PCI。主要终点在复杂 PCI 中更为常见（45.6%比 26.6%；P<0.001），主要由 4 型 MI 和血管造影并发症发生率较高所致（12.2%比 4.8%；P<0.001 和 19.3%比 8.6%；P<0.05）。48 小时（12.7%比 5.1%；P<0.05）和 30 天（13.4%比 5.3%；P<0.05）时死亡、MI 和卒中的复合终点在复杂 PCI 中更为常见。在主要终点（P=0.47）和次要终点方面，未发现 PCI 复杂性与随机治疗之间存在交互作用。
在慢性冠状动脉综合征患者中，与氯吡格雷相比，接受复杂 PCI 的患者围手术期和心血管事件发生率更高，而替格瑞洛并未降低这些事件的发生率。
