冠状动脉支架后双抗血小板治疗的短期和长期持续时间:一个随机的多中心试验
Marco Valgimigli1, Gianluca Campo, Monia Monti
1University of Ferrara, Cardiovascular Institute, Arcispedale S. Anna Hospital, Ferrara, Italy. vlgmrc@unife.it
Circulation
|March 23, 2012
概括
在冠状动脉支架后将双抗血小板治疗延长至24个月后,对于主要不良事件,在6个月内没有显著的益处. 然而,在接受药物排泄或裸金属支架的患者中,更长时间的治疗增加了出血风险.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 临床试验 临床试验
背景情况:
- 冠状动脉支架后双抗血小板治疗 (DAPT) 的最佳持续时间尚未确定.
- 长期DAPT的风险-收益需要进一步调查.
- 这项研究针对不同类型支架的多元患者群体的DAPT持续时间.
研究的目的:
- 为了比较冠状动脉支架后6个月和24个月的DAPT的疗效和安全性.
- 评估DAPT持续时间对主要心血管和脑血管不良事件的影响.
- 评估与不同的DAPT持续时间相关的出血风险.
主要方法:
- 2013年随机试验的患者接受裸金属,zotolimus排泄,paclitaxel排泄或everolimus排泄的支架.
- 患者被分配到6个月或24个月的克洛皮多格雷尔加阿司匹林治疗.
- 主要终点:死亡,心肌梗塞或脑血管事故的复合结果.
主要成果:
- 在6个月和24个月的DAPT组之间,2年后的初级结果没有显著差异 (10.0%与10.1%,HR 0.98,P=0.91).
- 死亡,心肌梗塞,脑血管事故和支架血栓形成的个体风险在各组之间相似.
- 在所有出血定义中,在24个月的DAPT中观察到出血的风险明显增加.
结论:
- 在支架后预防重大不良事件方面,24个月的克洛皮多格勒治疗方案并不优于6个月的治疗方案.
- 较长的DAPT持续时间 (24个月) 与出血事件的风险增加有关.
- 这些发现表明,需要根据患者的风险概况做出个性化DAPT持续时间决定.
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