皮肤冠状动脉干预后双重抗血小板治疗的个性化或标准持续时间:PARTHENOPE随机试验
Raffaele Piccolo1, Paolo Calabrò2, Greta Carrara3
1Department of Advanced Biomedical Sciences, University of Naples "Federico II", Italy; "Federico II" University Hospital, Naples, Italy.
Journal of the American College of Cardiology
|September 2, 2025
概括
与标准的12个月的DAPT相比,通过皮肤冠状动脉干预 (PCI) 后的个性化双重抗血小板治疗 (DAPT) 减少了不良临床事件. 这种个性化治疗方法在3至24个月的时间内降低了心肌梗塞和再血管化的风险,但没有增加出血.
科学领域:
- 心血管医学
- 干预心脏病学
- 临床试验
背景情况:
- 在皮肤冠状动脉干预 (PCI) 后,双重抗血小板治疗 (DAPT) 是标准的.
- 在PCI后的最佳DAPT持续时间仍然是一个活跃的研究和临床不确定性的领域.
- 目前的指导方针建议大多数PCI患者接受12个月的DAPT治疗.
研究的目的:
- 在接受PCI的患者中,将个性化的DAPT持续时间策略 (3, 6或24个月) 与标准的12个月DAPT进行比较.
- 评估基于风险分数的个性化DAPT持续时间的有效性和安全性.
- 确定个性化DAPT对净不良临床事件 (NACE) 的影响.
主要方法:
- 这是一项随机试验,涉及2107名接受PCI的患者.
- 患者被分配到个性化DAPT组或标准的12个月DAPT组.
- 主要终点是24个月后的NACE,死亡,心肌梗塞,中风,紧急再血管或严重出血 (BARC标准).
主要成果:
- 在个性化DAPT组中,NACE发生在18.6%,而在标准DAPT组中发生在22.2% (P=0.040).
- 在个性化DAPT组中,NACE的下降主要是由于心肌梗塞和急需的目标血管再血管化率较低.
- 在个性化和标准DAPT组中,出血事件的发生率相似.
结论:
- 基于临床风险评分的个性化DAPT持续时间策略 (3-24个月) 在PCI后减少NACE方面优于标准的12个月DAPT.
- 个性化DAPT有效降低了心肌梗塞和再血管化的缺血事件的风险.
- 与标准 DAPT 持续时间相比,这种个性化方法保持了类似的出血安全性.
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