血液风险和P2Y12抑制剂在所有患者的ST段升高心肌梗塞治疗皮肤冠状动脉干预:一个单中心队列研究
Mia Ravn Jacobsen1, Reza Jabbari1, Thomas Engstrøm1
1Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 7 2100 Copenhagen, Denmark.
概括
在接受皮肤冠状动脉干预 (PCI) 的ST段升高心肌梗塞 (STEMI) 患者中,很大一部分患有高出血风险 (HBR). 这些HBR患者经常接受强大的P2Y12抑制剂,这表明优先考虑缺血风险而不是出血风险.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在经皮冠状动脉干预 (PCI) 后,ST段升高心肌梗塞 (STEMI) 患者需要双重抗血小板治疗 (DAPT).
- 评估出血风险对于优化DAPT至关重要,特别是在高出血风险 (HBR) 的人群中.
- PRECISE-DAPT评分是用于预测DAPT患者出血并发症的验证工具.
研究的目的:
- 在HBR使用PRECISE-DAPT得分来描述STEMI患者.
- 检查HBR STEMI患者中P2Y12抑制剂的利用情况.
- 评估P2Y12抑制剂选择与重大心血管不良事件 (MACE) 和出血风险之间的关联.
主要方法:
- 一个单一中心的队列研究,包括6179名连续接受PCI的STEMI患者.
- 利用全国性的注册表来获得有关诊断,药物和生命状况的全面数据.
- 计算了PRECISE-DAPT风险分层的得分,并分析了P2Y12抑制剂的使用和临床结果.
主要成果:
- 在具有可用的PRECISE-DAPT分数的STEMI患者中,有33.0%被确定为HBR.
- HBR患者年龄较大,女性更频繁,并有更多的并发症.
- 在HBR患者中,大出血和MACE的一年发病率显著高于HBR患者 (8.7%和36.8%对2.1%和8.3%).
- 与克洛皮多格雷尔相比,HBR患者更有可能接受提卡格雷罗或普拉苏格雷尔治疗.
- 与克洛皮多格雷尔相比,提卡格雷罗/普拉苏格雷尔的使用与较低的MACE风险相关,而不会增加严重出血.
结论:
- 大约三分之一的接受PCI治疗的STEMI患者在HBR.
- 对于HBR患者,通常使用比克洛皮多格雷尔更强大的P2Y12抑制剂 (蒂卡格雷勒/普拉苏格雷尔) 治疗.
- 这种治疗模式表明,在HBR STEMI患者中,潜在的重点是管理缺血风险而不是出血风险.
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