トリプル対ダブル抗血小板治療は,STセグメント上昇急性心筋梗塞の患者で,初回皮経冠動脈介入を受けている患者で,トリプル対ダブル抗血小板治療である
Kang-Yin Chen1, Seung-Woon Rha, Yong-Jian Li
1Korea University Guro Hospital, Seoul, Korea.
Circulation
|June 17, 2009
まとめ
アスピリン,クロピドグレル,チロスタゾールを含む三重抗血小板治療は,ステントを施したSTセグメント上昇心筋梗塞の患者で二重治療よりも良い結果を示しました. このアプローチにより,心臓病および全死亡率が低下し,高齢者,女性,糖尿病患者で利益が見られた.
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:
- 薬剤排出ステント (DES) を使用したSTセグメント上昇心筋梗塞 (STEMI) に対する最適な抗血小板戦略のプライマリー経皮冠動脈介入 (PCI) 後の薬剤排出ステント (DES) は議論されています.
- ダブル抗血小板治療 (DAPT) とトリプル抗血小板治療 (TAPT) の有効性は,現在のDES時代では不明である.
研究 の 目的:
- DESによるプライマリPCIを受けたSTEMI患者におけるTAPT対DAPTの臨床アウトカムを比較する.
- TAPTからより多くの恩恵を受ける可能性のある患者のサブグループを特定する.
主な方法:
- 韓国急性心筋梗塞レジストリ (KAMIR) の4203人のSTEMI患者を遡及的に分析した.
- 患者はDAPT (アスピリン+クロピドグレル) またはTAPT (アスピリン+クロピドグレル+シロスタゾール) を1ヶ月以上受けた.
- 2つのグループ間の8ヶ月のメジャー・アドバース・カルディアック・イベント (MACE) と出血イベントの比較.
主要な成果:
- TAPTグループは,DAPTグループと比較して,同様の主要な出血イベントを示したが,病院での死亡率は有意に低下した.
- 8ヶ月で,TAPTは,心疾患による死亡率 (aOR 0.52),総死亡率 (aOR 0.60),および総MACE (aOR 0.74) を著しく低下させた.
- サブグループ分析は,高齢者 (>65歳),女性,糖尿病患者でTAPTのより大きな利点を示しました.
結論:
- トリプル抗血小板治療 (アスピリン,クロピドグレル,チロスタゾール) は,DESによるプライマリPCIを受けたSTEMI患者における二重抗血小板治療に優れているようです.
- これらの発見は,選択されたSTEMI患者の臨床結果を改善し,死亡率を減らすためにTAPTを検討することを支持しています.
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