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预测P2Y12抑制剂的耐药性的挑战:从ARTEMIS试验的角度来看
Jennifer A Rymer1, Zachary K Wegermann1, Lisa A Kaltenbach1
1Duke University School of Medicine Durham NC USA.
Journal of the American Heart Association
|June 10, 2023
概括
在心肌梗塞后改善P2Y12抑制剂的持续性至关重要. 不持续性预测模型的表现不佳,强调需要更好地教育患者和临床医生治疗的重要性.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 过早停止P2Y12抑制剂治疗与心脏不良事件有关.
- 目前的风险模型无法充分预测可能中止P2Y12抑制剂治疗的患者.
- 改善药物持续性是防止不良结果的关键.
研究的目的:
- 评估共付援助干预对P2Y12抑制剂持久性和心肌梗塞后结果的影响.
- 开发和评估1年P2Y12抑制剂不持久性的预测模型.
主要方法:
- 在ARTEMIS试验中,6212名心肌梗塞后患者被随机分配到通常的护理或共同支付援助.
- 非持久性被定义为P2Y12抑制剂处方填充的>30天间隔.
- 开发了一个53个变量的多变量模型来预测1年不持久性.
主要成果:
- 总体而言,1年P2Y12抑制剂的不持久性为47.9%.
- 共同支付援助显示,不持久性 (45.3%) 略有减少.
- 预测模型的歧视性很差 (C指数为0.58-0.62),即使是患者报告的数据.
结论:
- 在心肌梗塞后对P2Y12抑制剂治疗持续性的预测模型的准确性有限.
- 增强的患者报告变量并没有显著改善模型性能.
- 建议对患者和临床医生进行关于P2Y12抑制剂治疗的重要性的持续教育.
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