高缺血风险患者经皮冠状动脉介入治疗分叉病变后延长双联抗血小板治疗的影响。

Impact of Prolonged Dual Antiplatelet Therapy After Bifurcation Percutaneous Coronary Intervention in Patients with High Ischemic Risk.

机构信息

Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya st., Novosibirsk, 630055, Russian Federation.

Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, 625026, Russian Federation.

出版信息

Am J Cardiovasc Drugs. 2024 Jul;24(4):577-588. doi: 10.1007/s40256-024-00657-1. Epub 2024 Jun 13.

DOI:10.1007/s40256-024-00657-1

PMID:38871947

Abstract

BACKGROUND

The aim of this study was to evaluate the impact of prolonged dual antiplatelet therapy (DAPT) on clinical outcomes in patients undergoing percutaneous coronary interventions (PCI) for bifurcation coronary lesions.

METHODS

A total of 1000 patients who underwent PCI for coronary bifurcation lesions and had clinical follow-up were divided into two groups based on the duration of DAPT: DAPT > 12 months and DAPT ≤ 12 months). Patients who experienced a myocardial infarction, required repeat PCI, or died within 1 year after the initial procedure were excluded.

RESULTS

Among the 1000 eligible patients, 394 patients received DAPT for > 12 months (39.4%). Most patients in our study presented with chronic coronary disease (61%). The majority of patients in our study (62.8%) had a low bleeding risk. The median follow-up duration was 35 months (interquartile range 20.6-36.5). There were no significant differences in the major adverse cardiovascular events (MACE) between groups of prolonged DAPT (> 12 month) and DAPT ≤ 12 months (18.8% vs. 14.9%, p = 0.11). Patients with clinical features of high ischemic risk (HIR) had a significantly increased risk of MACE (hazard ratio [HR] 1.92, 95% confidence interval [CI] 1.12-3.26, p = 0.015) when compared with patients without clinical features of HIR. Compared with DAPT ≤ 12 months, extended DAPT (> 12 months) did not improve outcomes in patients with clinical (HR 1.24, 95% CI 0.90-1.72, p = 0.19) and technical features (HR 1.04, 95% CI 0.67-1.63, p = 0.85) of HIR.

CONCLUSION

In this multicenter real-world registry, administration of DAPT for more than 12 months in patients who have undergone PCI for bifurcation lesion is not associated with a reduced incidence of MACE in long-term follow-up.

REGISTRATION

ClinicalTrials.gov identifier no. NCT03450577.

摘要

背景

本研究旨在评估经皮冠状动脉介入治疗（PCI）分叉病变患者延长双联抗血小板治疗（DAPT）对临床结局的影响。

方法

共纳入 1000 例接受 PCI 治疗的分叉病变患者，并进行了临床随访，根据 DAPT 持续时间将患者分为两组：DAPT＞12 个月和 DAPT≤12 个月。排除了 1 年内发生心肌梗死、需要再次 PCI 或死亡的患者。

结果

在 1000 例合格患者中，394 例患者接受了＞12 个月的 DAPT（39.4%）。大多数患者存在慢性冠状动脉疾病（61%）。大多数患者（62.8%）的出血风险较低。中位随访时间为 35 个月（四分位距 20.6-36.5）。DAPT 延长组（＞12 个月）和 DAPT≤12 个月组的主要不良心血管事件（MACE）发生率无显著差异（18.8% vs. 14.9%，p=0.11）。与无临床高缺血风险特征的患者相比，有临床高缺血风险特征（HIR）的患者 MACE 风险显著增加（风险比[HR]1.92，95%置信区间[CI]1.12-3.26，p=0.015）。与 DAPT≤12 个月相比，在有临床（HR 1.24，95%CI 0.90-1.72，p=0.19）和技术（HR 1.04，95%CI 0.67-1.63，p=0.85）HIR 特征的患者中，延长 DAPT（＞12 个月）并未改善结局。