冠脉支架术后长期联用阿司匹林和氯吡格雷的有效性与安全性研究

Effect of combined application of aspirin and clopidogrel after percutaneous coronary intervention with acute coronary syndrome

目的观察急性冠脉综合征冠脉支架术后联合应用阿司匹林和氯吡格雷的疗效及安全性。方法将行冠脉支架术的611例冠心病患者按病情分为急性冠脉综合征组(ACS,n=424)和稳定性心绞痛组(SAP,n=187)。两组在冠脉支架术后长期联合应用(最短1个月,31.8%超过12个月)阿司匹林和氯吡格雷至随访结束。比较两组联合应用抗血小板的情况,观察两组患者主要心血管事件(心血管性死亡、心肌梗死、心肌缺血复发进行靶血管再通治疗)及抗血小板副作用(消化道出血、血小板减少、白细胞减少)的发生率。结果急性冠脉综合征组发生76例心血管事件(死亡15例,心肌梗死10例、靶血管再通治疗45例,卒中6例);稳定性心绞痛组发生25例心血管事件(心血管性死亡8例,心肌梗死1例,靶血管再通治疗14例,卒中2例),组间差异无显著性(P>0.05);阿司匹林及氯吡格雷负荷量差异有显著性,联合应用超过12个月例数差异无显著性意义;两组抗血小板副作用(消化道出血、血小板减少、白细胞减少)的发生率间差异无显著性(P>0.05)。结论急性冠脉综合征组冠脉支架术后长期联合应用阿司匹林和氯吡格雷安全、有效,可减少冠脉支架术后心血管事件的发生,出血、血小板减少、白细胞减少等抗血小板药物并发症无明显增加。

Objective To investigate the effect and safeness percutaneous coronary intervention with acute coronary syndrome. of combined application of aspirin and clopidogrel after Methods 611 patients received percutaneous coronary intervention （PCI） with coronary heart disease were divided into acute coronary syndrome group （ACS, 424 cases） and stable angina pectoris group （SAP,187 cases）by diagnosis. The patients in two groups were administered with aspirin and clopidogrel after PCI operation. The incidence of major cardiovascular events （cardiovascular death, myocardial infarctions, re-building operation of blood flow for target vessel due to myocardial ischemia, apoplexy） and the side reaction of anti-platelet therapy （hemorrhagic events, thrombocytopenia, leukopenia） were observed. Results There were 76 cases of cardiac events （15case of cordial death, 10 cases of myocardial infarctions,45 cases of re-building operation of blood flow for target vessel and 6 cases of apoplexy） in ACS group. In SAP group, there were 25 cases of cardiac events（8 case of cordial death, 1 cases of myocardial infarction, 14 cases of reuilding operation of blood flow for target vessel and 6 cases of apoplexy）. There was no significant difference in the side reaction of anti-platelet therapy （hemorrhagic events, thrombocytopenia, leukopenia） between the two groups（P〉0.05）. Conclusion A long period of combined application of aspirin and clopidogrel after percutaneous coronary intervention was safe and effective, which could reduce the occurrence of cardiovascular events after PCI operariots, with no obvious increase of anti-platelet therapy complication about hemorrhage, thrombocytopenia and leucopenia.