Zheng Wen, Huang Xin, Wang Xiao, Suo Min, Yan Yan, Gong Wei, Ai Hui, Que Bin, Nie Shaoping
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing 100029, China.
Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Haidian District, Beijing 100000, China.
Eur Heart J Open. 2024 Mar 27;4(2):oeae009. doi: 10.1093/ehjopen/oeae009. eCollection 2024 Mar.
With an aging population and better survival rates, coronary artery disease (CAD) with multimorbidity has become more prevalent, complicating treatment and impacting life quality and longevity. This study identifies multimorbidity patterns in CAD patients and their effect on clinical outcomes, emphasizing treatment strategies.
The study analysed data from the DCEM registry (173 459 patients) and BleeMACS cohort (15 401 patients) to categorize CAD patients into three multimorbidity patterns. The focus was on how these patterns influence outcomes, especially concerning the efficacy and safety of dual antiplatelet therapy (DAPT). The study identified three distinct multimorbidity patterns: Class 1 encompassed cardiovascular-kidney-metabolic comorbidities indicating the highest risk; Class 2 included hypertension-dyslipidaemia comorbidities, reflecting intermediate risk; and Class 3 involved non-specific comorbidities, indicating the lowest risk. Class 1 patients demonstrated a six-fold increase in in-hospital mortality and a four-fold increase in severe in-hospital complications compared with Class 3. Over a 1-year period, Class 1 was associated with the highest risk, displaying a significant increase in all-cause mortality [adjusted hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.52-2.31, < 0.001] and a notable risk for major bleeding (adjusted HR 1.74, 95% CI 1.36-2.24, < 0.001) compared with Class 3. The use of DAPT, particularly aspirin combined with clopidogrel, significantly reduced the 1-year all-cause mortality in Class 1 patients (adjusted HR 0.60, 95% CI 0.37-0.98, = 0.04) without increasing in major bleeding.
Coronary artery disease patients with a cardiovascular-kidney-metabolic profile face the highest mortality risk. Targeted DAPT, especially aspirin and clopidogrel, effectively lowers mortality without significantly raising bleeding risks.
DCEM registry (NCT05797402) and BleeMACS registry (NCT02466854).
随着人口老龄化和生存率提高，合并多种疾病的冠状动脉疾病（CAD）愈发普遍，使治疗复杂化并影响生活质量和寿命。本研究确定CAD患者的多种疾病模式及其对临床结局的影响，强调治疗策略。
该研究分析了DCEM注册研究（173459例患者）和BleeMACS队列研究（15401例患者）的数据，将CAD患者分为三种多种疾病模式。重点在于这些模式如何影响结局，特别是关于双联抗血小板治疗（DAPT）的疗效和安全性。研究确定了三种不同的多种疾病模式：1类包括心血管-肾脏-代谢共病，表明风险最高；2类包括高血压-血脂异常共病，反映中度风险；3类涉及非特异性共病，表明风险最低。与3类相比，1类患者住院死亡率增加了6倍，严重住院并发症增加了4倍。在1年期间，1类与最高风险相关，与3类相比，全因死亡率显著增加[调整后风险比（HR）1.87，95%置信区间（CI）1.52-2.31，<0.001]，且大出血风险显著（调整后HR 1.74，95%CI 1.36-2.24，<0.001）。使用DAPT，尤其是阿司匹林联合氯吡格雷，显著降低了1类患者的1年全因死亡率（调整后HR 0.60，95%CI 0.37-0.98，=0.04），且未增加大出血风险。
具有心血管-肾脏-代谢特征的冠状动脉疾病患者面临最高的死亡风险。针对性的DAPT，尤其是阿司匹林和氯吡格雷，可有效降低死亡率，而不会显著增加出血风险。
DCEM注册研究（NCT05797402）和BleeMACS注册研究（NCT02466854）。
