经皮冠状动脉介入治疗成功后慢性完全闭塞患者1个月与12个月双联抗血小板治疗对比

1-Month Versus 12-Month Dual Antiplatelet Therapy for Patients with Chronic Total Occlusion After Successful Percutaneous Coronary Intervention.

作者信息

Zhao Shuai, Zhu Boda, Chen Yan, Yu Tiantong, Zhang Bohui, Zhang Xi, Han Peng, Chen Youhu, Chen Genrui, Yang Li, Tan Zhijun, Wang Gang, Jin Sida, Yang Yi, Wang Rutao, Li Chengxiang, Lian Kun

机构信息

Department of Cardiology, Air Force Hospital of Western Theater Command, Chengdu, 610000, Sichuan, China.

Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, Shaanxi, China.

出版信息

Drugs Aging. 2025 Oct;42(10):975-985. doi: 10.1007/s40266-025-01235-z. Epub 2025 Aug 2.

DOI:10.1007/s40266-025-01235-z

PMID:40751899

Abstract

PURPOSE

Compared with long-term dual antiplatelet therapy (DAPT, aspirin with clopidogrel or ticagrelor), short-term DAPT followed by single antiplatelet therapy (SAPT, clopidogrel or ticagrelor) has demonstrated superiority in reducing bleeding risk while maintaining non-inferior in cardiovascular benefits in coronary heart disease (CHD) after successful percutaneous coronary intervention (PCI). However, no prospective study has explored the benefits of this short-term regimen on patients with chronic total occlusion (CTO) undergoing PCI.

METHODS

Consecutive patients who underwent successful elective CTO-PCI were prospectively enrolled from April 2019 to May 2021. After receiving 1-month DAPT, all patients were divided into two groups: SAPT group (followed by clopidogrel or ticagrelor monotherapy) and DAPT group (continued with dual antiplatelet therapy). Detailed baseline characteristics, angiographic and procedural details, and 1-year follow-up data were collected. The endpoints were major adverse cardiovascular events (MACE) and bleeding.

RESULTS

A total of 701 patients who underwent successful CTO-PCI were enrolled, among whom 330 patients (47.1%) received DAPT and 371 patients (52.9%) received SAPT (clopidogrel or ticagrelor) after 1-month DAPT. Compared with patients receiving DAPT, patients in the SAPT (clopidogrel or ticagrelor) group had a lower rate of previous stroke, fewer left anterior descending coronary artery (LAD) lesions and contrast volume, and fewer lesions per patient, but longer lesion length (P < 0.05). The incidence of MACE (14.5% versus 15.4%; p = 0.742) was not significantly different between the two groups. The DAPT group showed a higher incidence of minor bleeding (BARC types 1 or 2; 12.7% versus 2.3%, p < 0.001) than SAPT (clopidogrel or ticagrelor), while no difference was found for major bleeding (BARC types 3 or 5; 1.2% versus 2.3%, p = 0.261).

CONCLUSIONS

Compared with standard 12-month DAPT, 1-month DAPT followed by clopidogrel or ticagrelor monotherapy resulted in lower bleeding risks and similar cardiovascular benefits in CTO-PCI patients.

摘要

目的

与长期双联抗血小板治疗（DAPT，阿司匹林联合氯吡格雷或替格瑞洛）相比，短期DAPT后序贯单药抗血小板治疗（SAPT，氯吡格雷或替格瑞洛）在降低出血风险方面已显示出优势，同时在成功进行经皮冠状动脉介入治疗（PCI）后的冠心病（CHD）患者中维持心血管获益不劣于长期治疗。然而，尚无前瞻性研究探讨这种短期治疗方案对接受PCI的慢性完全闭塞（CTO）患者的益处。

方法

前瞻性纳入2019年4月至2021年5月期间成功接受择期CTO-PCI的连续患者。在接受1个月的DAPT后，所有患者被分为两组：SAPT组（随后接受氯吡格雷或替格瑞洛单药治疗）和DAPT组（继续双联抗血小板治疗）。收集详细的基线特征、血管造影和手术细节以及1年随访数据。终点为主要不良心血管事件（MACE）和出血。

结果

共纳入701例成功接受CTO-PCI的患者，其中330例（47.1%）在接受1个月DAPT后接受DAPT治疗，371例（52.9%）接受SAPT（氯吡格雷或替格瑞洛）治疗。与接受DAPT的患者相比，SAPT（氯吡格雷或替格瑞洛）组患者既往卒中发生率较低，左前降支冠状动脉（LAD）病变和造影剂用量较少，每位患者的病变较少，但病变长度较长（P<0.05）。两组之间MACE的发生率（14.5%对15.4%；p=0.742）无显著差异。DAPT组轻微出血（BARC 1或2型；12.7%对2.3%，p<0.001）的发生率高于SAPT（氯吡格雷或替格瑞洛）组，而严重出血（BARC 3或5型；1.2%对2.3%，p=0.261）无差异。