老年糖尿病冠心病患者支架植入术后抗血小板治疗的研究

The prospective randomized study of antiplatelet therapy after stent implantation for elder diabetic patients with coronary heart disease and hemorrhagic stroke history

目的探讨有出血性卒中病史的老年糖尿病冠心病患者金属裸支架(BMS)植入术后,三联抗血小板治疗预防支架内血栓形成和再狭窄的有效性及安全性。方法 60例患者支架植入术后按1:1分为治疗组和对照组。两组均长期服用阿司匹林日100mg,氯吡格雷日75mg(1个月)。治疗组加用西洛他唑日200mg(6个月)。6～9个月后冠脉造影(CA)随访。结果 9个月主要心脑血管事件发生率,治疗组低于对照组(P<0.05)。6个月CA随访结果,最小管腔直径(MLD)治疗组高于对照组(2.15±0.57mm vs 1.81±0.36mm,P<0.05)。管腔晚期丢失(0.71±0.19mm vs 1.28±0.33mm)、再狭窄率(RR,13.8%vs 37%)、靶病变重建率(TLR,13.3% vs 34.5%),治疗组均低于对照组(P均<0.05)。结论对冠脉病变参考血管直径≥3.0mm且病变长度≤20mm、合并出血性卒中史的老年糖尿病冠心病患者,可考虑用BMS;并在两联抗血小板治疗基础上,加用6个月西洛他唑,有降低支架内血栓形成的趋势,增加随访期的MLD、减少BMS术后RR和TLR,且不增加出血并发症。

Objective To investigate the safety and efficacy of triple antiplatelet therapy after bare metal stent implantation（BMS） for the prevention of late restenosis and stent thrombosis in elder diabetes mellitus（DM） combined with coronary heart disease and hemorrhagic stroke history. Methods 60 elder patients who underwent elective stent implantation were randomly assigned to treatment group and control group by 1 ： 1. Both groups took aspirin 100mg/d for life long and clopidogrel 75 mg/d for one month. The treatment group took cilostazol 200mg/d for six month in addition. Follow-up coronary angiography was performed 6-9 months later. Results Major adverse cardio-cerebral events （MACCE） at nine months follow up were lower in treatment versus control groups （P〈0. 05）. The minimum lumen diameter（MLD） at 6 months follow up was higher in treatment group than in control group（2. 15±0. 57mm vs 1.81±0. 36ram,P〈0. 05）. Late lumen loss （LL） （0. 71± 0. 19mm vs 1.28 ± 0. 33 mm）, restenosis rate（RR） （13.8% vs 37%） and target lesion revascularizaion（TLR） rate （13.3% vs 34. 5%） were all lower in treatment group than in control group（all P〈 0. 05）. Conclusions For the elderly with DM, CAD and hemorrhagic stroke history, if the reference vessel diameter ≥3.0ram and lesion length ≤20mm, BMS is an alternation choice. Cilostazol-combined aspirin and clopidogrel therapy is an effective regimen for decreasing not only stent thrombosis but also RR and TLR through reducing MLD without the risk of increasing bleeding.