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クロピドグレルの使用と,薬物排出ステントの埋め込み後の長期的な臨床結果

Eric L Eisenstein¹, Kevin J Anstrom, David F Kong

¹Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA. eric.eisenstein@duke.edu

|December 7, 2006

まとめ

薬剤排出ステント (DES) の患者におけるクロピドグレルの長期使用は,死亡と心筋梗塞 (MI) のリスクを軽減する可能性があります. しかし,最適な持続期間は,臨床試験でのさらなる研究を必要とします.

科学分野:

心臓病学心臓病学
介入性心臓病学介入性心臓病学
薬理学薬理学とは

背景:

現在の抗血小板療法では,薬剤排出ステント (DES) 植入後の後期ステント血栓の予防には不十分である可能性があります.
冠動脈内ステントで治療された冠動脈動脈疾患の患者における抗血小板薬の使用に関連する長期的なアウトカムを評価するために,観察研究が必要である.

研究の目的:

クロピドグレルの使用と薬物排出ステント (DES) と裸金属ステント (BMS) を投与している患者の長期的な臨床結果との関連性を評価する.
クロピドグレルの使用がステント移植後の死亡率と心筋梗塞 (MI) に影響するかどうかを判断する.

主な方法:

BMSまたはDESによる皮膚経冠動脈介入を受けた4666人の患者を対象とした観察研究.
画期的な分析は,処置後6ヶ月と12ヶ月で実施され,ステントのタイプとクロピドグレルの使用に基づいて患者を分類しました.
評価されたアウトカムには,死亡,非致死性MI,および24ヶ月のフォローアップで死亡またはMIの複合が含まれていました.

主要な成果:

6ヶ月のDES患者の中で,クロピドグレルの使用は,24ヶ月の死亡率と死亡率またはMIの著しく低い割合に関連していました.
6ヶ月でイベントのないBMS患者では,クロピドグレルの使用で死亡または死亡またはMIの有意な違いは観察されなかった.
12ヶ月でイベントのない患者の分析でも同様の結果が認められ,DES患者におけるクロピドグレルの使用は死亡率や死亡率またはMIの低下を予測した.

結論:

DES患者におけるクロピドグレルの長期使用は,死亡および死亡またはMIのリスクを低下させる可能性があります.
クロピドグレル投与の最適な期間は,大規模なランダム化臨床試験によって決定する必要があります.

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