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里瓦罗克萨班加上阿司匹林与单独的阿司匹林在患者之前穿皮冠状动脉干预 (COMPASS- PCI)

Kevin R Bainey¹, Robert C Welsh¹, Stuart J Connolly²

¹Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., R.C.W.).

|March 18, 2020

概括

在慢性冠状动脉综合征患者中,与里瓦罗克萨班和阿司匹林的双通道抑制 (DPI) 显著降低了主要的不良心血管事件 (MACE) 和死亡率,无论之前是否进行过穿皮冠状动脉干预 (PCI). 然而,DPI也增加了严重出血的风险.

科学领域:

心血管医学
药理学
临床试验

背景情况:

在慢性冠状动脉综合征或外周动脉疾病患者中,Rivaroxaban和阿司匹林的双通道抑制 (DPI) 已被确定为有效降低主要心血管不良事件 (MACE) 和死亡率.
通过皮肤冠状动脉干预 (PCI) 病史的患者中DPI的疗效和安全性仍未得到 COMPASS 初级试验的研究结果.

研究的目的:

在以前接受过PCI的慢性冠状动脉综合征患者中,研究DPI (里瓦洛克萨班加阿司匹林) 与单独阿司匹林的有效性和安全性.
分析之前的PCI时间对DPI治疗结果的影响.

主要方法:

针对慢性冠状动脉综合征患者进行了COMPASS试验的预定小组分析.
用DPI治疗的患者和仅用阿司匹林治疗的患者之间的结果进行了比较,具体地检查了以前有PCI和没有PCI的小组.
对于以前进行过PCI的患者,治疗效果是根据干预后的时间进行评估的.

主要成果:

与单独阿司匹林相比,DPI显著降低了MACE (4. 0%与5. 5%相比) 和死亡率 (2. 5%与3. 5%相比),无论PCI发生多久,都观察到一致的益处.
这些益处反映在没有PCI的患者中,在两组中都显示出一致的疗效 (MACE: 4. 4%与5. 7%;死亡率: 4. 1%与5. 0%).
在这两组患者中,DPI与严重出血的风险增加有关 (PCI: 3. 3%与2. 0%;没有PCI: 2. 9%与1. 8%).

结论:

在患有慢性冠状动脉综合征的患者中,利瓦罗克萨班和阿司匹林的双重途径抑制可使MACE和死亡率持续降低,不论之前的PCI史或PCI以来的时间.
在这两种患者群体中,必须仔细考虑与DPI治疗相关的严重出血风险.
这些发现支持在某些患有慢性冠状动脉综合征和PCI病史的患者中使用DPI,以平衡疗效和出血风险.

关键词:

动脉样硬化冠状动脉疾病通过皮肤进行冠状动脉干预

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