在急性ST段升高心肌梗塞患者接受初级皮肤冠状动脉干预的三重或双重抗血小板治疗中
Kang-Yin Chen1, Seung-Woon Rha, Yong-Jian Li
1Korea University Guro Hospital, Seoul, Korea.
Circulation
|June 17, 2009
概括
三重抗血小板治疗,包括阿司匹林,克洛皮多格雷尔和西洛斯塔,在接受支架的ST段升高心肌梗塞患者中显示出比双重治疗更好的结果. 这种方法减少了心脏病和总死亡,在老年,女性和糖尿病患者中看到了好处.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在ST段升高心肌梗塞 (STEMI) 的初级皮肤穿冠状动脉干预 (PCI) 后使用药物排泄支架 (DES) 进行最佳抗血小板策略的讨论.
- 在当前的DES时代,双抗血小板治疗 (DAPT) 与三重抗血小板治疗 (TAPT) 的疗效仍然不清楚.
研究的目的:
- 为了比较TAPT与DAPT在STEMI患者的临床结果,这些患者接受了DES的初级PCI.
- 确定可能从TAPT中受益更多的患者子组.
主要方法:
- 来自韩国急性心肌梗塞登记处 (KAMIR) 的4203名STEMI患者的回顾性分析.
- 患者接受了DAPT (阿司匹林+克洛皮多格雷尔) 或TAPT (阿司匹林+克洛皮多格雷尔+西洛斯塔) 治疗,持续时间≥1个月.
- 两组之间8个月内主要不良心脏事件 (MACE) 和出血事件的比较.
主要成果:
- 与DAPT组相比,TAPT组表现出类似的重大出血事件,但在医院内死亡率明显较低.
- 在8个月后,TAPT与显著降低心脏死亡率 (aOR 0.52),总死亡率 (aOR 0.60) 和总MACE (aOR 0.74) 相关.
- 亚组分析表明,TAPT对老年 (>65岁),女性和糖尿病患者的益处更大.
结论:
- 三重抗血小板治疗 (阿司匹林,克洛皮多格雷尔和西洛斯塔) 在接受DES初级PCI的STEMI患者中似乎优于双重抗血小板治疗.
- 这些发现支持考虑TAPT用于选择的STEMI患者,以改善临床结果和降低死亡率.
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