冠状动脉介入治疗术后三联抗血小板治疗的近期疗效

Short-term outcomes of triple antiplatelet therapy after percutaneous coronary intervention

目的评价冠状动脉介入治疗(PCI)后应用西洛他唑联合阿司匹林和氯吡格雷三联抗血小板治疗方案的近期疗效和安全性。方法回顾性分析2001年10月至2005年4月沈阳军区总医院心内科接受PCI治疗的病例,共1103例患者于PCI后应用三联抗血小板治疗,对照组为同期PCI后服用阿司匹林联合氯吡格雷两联抗血小板治疗者2032例。比较两组患者PCI后30d主要不良心脏事件(MACE)、亚急性血栓(SAT)和出血发生率。结果三联组接受支架治疗为91·3%(1007/1103),多支病变占68·3%(753/1103),无保护左主干病变占7·1%(78/1103)。对照组接受支架治疗为89·1%(1910/2032),多支病变占63·3%(1286/2303,P<0·01),无保护左主干病变4·6%(94/2032),三联组均高于对照组(P<0·01),慢性完全闭塞病变接受PCI的比例低于对照组[10·8%(119/1103)比13·4%(272/2032),P<0·05]。两组术中均无死亡;三联组30d病死率0·4%(4/1103),MACE发生率1·3%(14/1103)均显著低于对照组1·6%(32/1032),2·6%(53/2032,P<0·05)。两组SAT[0·7%(8/1103)比1·0%(21/2032)]和30d主要出血事件发生率[0·3%(3/1103)比0·2%(4/2032)]差异均无统计学意义。结论PCI后应用氯吡格雷、阿司匹林和西洛他唑三联抗血小板治疗是安全的,与常规氯吡格雷和阿司匹林两联抗血小板治疗相比可显著降低近期死亡和MACE发生率,但还需随机临床试验证实。

Objective To evaluate short-term efficacy and safety of triple antiplatelet regimen （cilostazol combined with clopidogrel and aspirin ） in patients who underwent pereutaneous coronary intervention （PCI）. Methods From October 2001 to April 2005, a total of 3135 patients underwent PCI in the General Hospital of Shenyang Command, People＇s Liberation Army, of which 1103 were treated with cilostazol 100 mg twice a day for 6 months in addition to aspirin and clopidogrel for 3 - 12 months as triple antiplatelet therapy regimen （triple group） after PCI, and 2032 of which received aspirin and clopidogrel for 3 - 12 months as dual antiplatelet therapy regimen after PCI （control group）. The data of the incidence rates of major adverse cardiac events （ MACE ）, subacute in-stent thrombosis （ SAT）, and hemorrhage events within 30 days after PCI of the two groups were retrospectively analyzed. Results The baseline clinical characteristics were comparable between these two groups. However, the proportions of the patients receiving stent implantation, with multivessel coronary artery diseases, and receiving PCI for unprotected left main trunk diseases of the triple group （91.3%, 68. 3 %, and 7. 1% respectively） were all significantly higher than those of the control group （89. 1%, 63.3 %, and 4.6 %, P 〈0. 05, P 〈0. 01, and P 〈0. 01 ）. The proportion of patients with chronic total occlusions who received PCI in the triple group was 10. 8%, significantly lower than that of the control group （ 13.4%, P 〈0. 05 ）. No death occurred during procedure in both groups. The 30 d mortality and the rate of MACE with 30 days after PCI of the triple group were 0. 4% and 1.3%, both significantly lower than those of the control group （ 1.6 %, and 2.6%, both P 〈 0. 05）. However, there were no significant differences in the incidence rates of SAT and major hemorrhage events between these 2 groups （0. 7 % vs 1.0% and 0. 3% vs. 0. 2% respectively, both P 〉 0. 05 ）.Conclusion This novel triple antiplatelet regimen （aspirin and clopidogrel combined with cilostazol） for PCI patients is safe and more efficient than the dual antiplatelet therapy regimen （clopidogrel and aspirin） in reducing mortality and incidence of MACE in a short-term period.