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心肌梗塞后1年以上的双重抗血小板治疗与仅用低剂量阿司匹林相比:在法国SNDS全国索赔数据库中进行了为期3年的随访队列研究
Patrick Blin1, Nicolas Danchin2, Jacques Benichou3
1Université de Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 33000, Bordeaux, France. patrick.blin@u-bordeaux.fr.
概括
在心肌梗塞 (MI) 发生一年后继续双重抗血小板治疗 (DAPT) 没有显示出与单独服用低剂量阿司匹林相比的显著益处. 这一发现影响了心脏病发作幸存者的二次预防策略.
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.
- 健康 结果 研究 研究 结果
背景情况:
- 使用低剂量阿司匹林和P2Y12抑制剂的双抗血小板治疗 (DAPT) 是心肌梗塞 (MI) 后二次预防的标准.
- 达普特心脏病后心脏病的最佳持续时间仍未确定,因此需要进一步研究治疗策略.
研究的目的:
- 为了比较继续使用DAPT的患者和转换为仅用低剂量阿司匹林的患者在心脏病发作后1年后的3年后的结果.
- 评估扩展DAPT与阿司匹林单疗法在二次性心脏病发作预防中的疗效和安全性.
主要方法:
- 一项法国全国范围的索赔数据库队列研究包括51468名心脏病中幸存的成年人,并接受了至少1年的DAPT治疗.
- 使用依赖时间的Cox比例危险或Fine-Gray模型来比较结果,并根据高维疾病风险得分进行调整.
- 主要结局是心脏病发作,中风,大出血或所有原因死亡的综合结合,在心脏病发作后3年内.
主要成果:
- 与低剂量阿司匹林相比,DAPT的危险比率为0.93 (初级组合),0.93 (二级组合),1.04 (MI),0.91 (中风),1.19 (严重出血) 和0.94 (死亡).
- 对于初级综合结果 (HR 0.93;95% CI 0.85-1.03) 或其组件,在两组之间没有观察到统计学上显著的差异.
- 与阿司匹林单疗法相比,延长超过一年的DAPT在减少主要不良心血管事件或死亡方面没有显著的益处.
结论:
- 持续的双重抗血小板治疗 (DAPT) 超过1年心肌梗塞 (MI) 后,与低剂量阿司匹林单疗法相比,没有显著的优势.
- 研究结果表明,仅用低剂量阿司匹林可能是选择患者中心脏病发作后的长期二次预防的充分策略.
- 进一步的研究可能会根据个体患者的风险概况探索个性化治疗持续时间.
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