冠状动脉旁路移植术后的心源性猝死及抗血小板治疗的作用
Sudden cardiac death after coronary artery bypass graft surgery and role of antiplatelet therapy.
作者信息
Ch Iftikhar Ali, Chaudhry Azhar, Zehra Mishal, Wu Pei-Tzu, Tahirkheli Mashal, Bai Poonam, Bhaktaram Ananya, Jamal Rahat, Chaudry Sabrina, Amil Faris, Randolph John, Miller Steven, Garrett Jeffrey, Tahirkheli Naeem
机构信息
South Oklahoma Heart Research, Oklahoma City, Oklahoma, United States of America.
SSM Health Saint Anthony Hospital, Oklahoma City, Oklahoma, United States of America.
出版信息
PLoS One. 2025 Feb 25;20(2):e0319292. doi: 10.1371/journal.pone.0319292. eCollection 2025.
BACKGROUND
While coronary artery bypass grafting (CABG) surgery is effective in reducing the risk of myocardial infarction and subsequent cardiac events by improving myocardial perfusion, the risk of sudden cardiac death (SCD) remains notable.
METHODS
This retrospective observational study evaluated the efficacy of dual antiplatelet therapy (DAPT) in preventing sudden cardiac death (SCD) among patients undergoing CABG surgery at a major U.S. cardiac center (2012-2015). Data was manually extracted from electronic medical records between 23/04/2017 to 30/03/ 2018 and verified for accuracy, with patients categorized into DAPT or aspirin monotherapy groups based on discharge prescriptions.
RESULTS
Of 2,476 patients followed in this post-CABG study, the analysis included 1,005 patients who received aspirin monotherapy (AMT) and 1,458 patients who received dual antiplatelet therapy (DAPT). AMT group had a significantly higher incidence of SCD compared to those on DAPT (3.1% vs 0.8%; OR = 3.831, 95% CI: 1.961-7.519; p < 0.001). The binary regression model indicated that a higher BMI was associated with an increased risk of SCD (HR = 1.064, 95% CI: 1.012-1.118, p = 0.014). However, patients prescribed P2Y12 antagonists (HR = 0.285, 95% CI: 0.135-0.603, p < 0.001), those with a GFR > 60 ml/min (HR = 0.314, 95% CI: 0.158-0.624, p < 0.001), and those with a higher ejection fraction (HR = 0.962, 95% CI: 0.939-0.986, p = 0.002) were less likely to experience SCD following CABG. A 1 kg/m2 increase in BMI is associated with a 6.4% increase in the risk of SCD. Morbidly obese patients with BMI > 35 were more likely to have experienced SCD than those with BMI < 35 (HR = 2.400, 95% CI: 1.204-4,787; p = 0.013). Similarly, patients with EF > 40% had decreased incidence of SCD compared to those with EF < 40% (HR 0.347, 95% CI:0.158-0.763; p = 0.008). Patients on AMT had higher all-cause (OR = 2.136, 95% CI 1.502-3.038; p < 0.001) and CV mortality (OR = 3.731, 95% CI 2.233-6.235; p < 0.001) but had lower incidence of major bleeding (by drop in hemoglobin criteria) (OR = 0.704, 95% CI: 0.595-0.833; p < 0.001) compared to the DAPT group.
CONCLUSION
DAPT prescription after CABG improves survival and lowers risk of sudden cardiac death.
背景
虽然冠状动脉旁路移植术（CABG）通过改善心肌灌注有效降低心肌梗死风险和后续心脏事件，但心脏性猝死（SCD）风险仍然显著。
方法
这项回顾性观察性研究评估了双重抗血小板治疗（DAPT）在美国一家大型心脏中心（2012 - 2015年）接受CABG手术患者中预防心脏性猝死（SCD）的疗效。数据于2017年4月23日至2018年3月30日从电子病历中手动提取并验证准确性，患者根据出院处方分为DAPT组或阿司匹林单药治疗组。
结果
在这项CABG术后研究随访的2476例患者中，分析包括1005例接受阿司匹林单药治疗（AMT）的患者和1458例接受双重抗血小板治疗（DAPT）的患者。与DAPT组相比，AMT组SCD发生率显著更高（3.1%对0.8%；OR = 3.831，95%CI：1.961 - 7.519；p < 0.001）。二元回归模型表明，较高的BMI与SCD风险增加相关（HR = 1.064，95%CI：1.012 - 1.118，p = 0.014）。然而，开具P2Y12拮抗剂的患者（HR = 0.285，95%CI：0.135 - 0.603，p < 0.001）、估算肾小球滤过率（GFR）> 60 ml/min的患者（HR = 0.314，95%CI：0.158 - 0.624，p < 0.001）以及射血分数较高的患者（HR = 0.962，95%CI：0.939 - 0.986，p = 0.002）在CABG术后发生SCD的可能性较小。BMI每增加1 kg/m²，SCD风险增加6.4%。BMI > 35的病态肥胖患者比BMI < 35的患者更易发生SCD（HR = 2.400，95%CI：1.204 - 4.787；p = 0.013）。同样，射血分数（EF）> 40%的患者与EF < 40%的患者相比，SCD发生率降低（HR = 0.347，95%CI：0.158 - 0.763；p = 0.008）。与DAPT组相比，AMT组患者全因死亡率（OR = 2.136，95%CI：1.502 - 3.038；p < 0.001）和心血管死亡率（OR = 3.731，95%CI：2.233 - 6.235；p < 0.001）更高，但大出血发生率（根据血红蛋白下降标准）更低（OR = 0.704，95%CI：0.595 - 0.833；p < 0.001）。
结论
CABG术后开具DAPT可提高生存率并降低心脏性猝死风险。
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