在双抗血小板治疗研究中最佳医疗疗法的影响
Charles D Resor1, Ashwin Nathan1, Dean J Kereiakes1
1From Division of Cardiology and Center for Clinical Biometrics, Department of Medicine, Brigham and Women's Hospital, Boston, MA (C.D.R., L.M.); Harvard Clinical Research Institute, Boston, MA (R.W.Y., D.E.C., W.-H.H., L.M.); Harvard Medical School, Boston, MA (R.W.Y., L.M.); Division of Cardiology, University of Pennsylvania Medical Center, Philadelphia (A.N.); Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y., D.E.C.); Department of Biostatistics, Boston University School of Public Heath, MA (J.M.M.); The Christ Hospital Heart and Vascular Center and The Lindner Center for Research and Education, Cincinnati, OH (D.J.K.); Université Paris-Diderot, INSERM U-1148, Hôpital Bichat, Département Hospitalo-Universitaire Fibrosis, Inflammation, and Remodeling, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); and National Heart and Lung Institute, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, Imperial College, London, UK (P.G.S.).
在冠心病患者中,不论他们处于最佳治疗状态 (OMT) 中,持续治疗皮素都显著降低了心肌梗塞的发生率. 这种双重抗血小板治疗策略也持续降低了主要的心血管不良事件和增加的出血风险.
科学领域:
- 心血管医学
- 临床试验
- 药理学
背景情况:
- 最佳药物治疗 (OMT) 和双抗血小板治疗 (DAPT) 改善了冠心病的结果.
- OMT对DAPT有效性的影响尚不清楚.
研究的目的:
- 在冠状动脉支架后的患者中,研究最佳治疗 (OMT) 是否会改变延长的双抗血小板治疗 (DAPT) 的治疗效果.
- 在接受OMT或不接受OMT的患者中,评估延续丁胺治疗的疗效和安全性.
主要方法:
- 在最初一年的DAPT治疗后,DAPT研究将11, 648名患者随机分为18个月的持续皮或安慰剂.
- OMT被定义为同时使用他类药物,β抑制剂和ACE抑制剂/ARB.
- 结果包括心肌梗塞,主要心血管不良事件和出血.
主要成果:
- 不论OMT状态 (相互作用P=0. 103) 持续使用提诺皮里丁可以减少心肌梗塞.
- 持续服用皮瑞丁可以降低主要心血管和脑血管不良事件的发生率,在非OMT患者中观察到显著效应 (HR,0. 63;P< 0. 001).
- 在OMT治疗的患者中,持续服用丁胺的出血率增加 (HR,2. 13;P< 0. 001),但在OMT治疗的患者中,出血率没有显著增加 (HR,1. 30;P=0. 189).
结论:
- 不论OMT如何,持续的丁胺治疗有效降低了冠心病患者的心肌梗塞的发生率.
- 延长DAPT对主要心血管不良事件的益处和相关的出血风险应在OMT使用的背景下考虑.
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