氯吡格雷用药时间对接受急诊介入治疗急性心肌梗死患者临床疗效的影响

Effect of duration of clopidogrel use on clinical follow-up outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

目的 评价氯吡格雷用药时间对接受急诊冠状动脉介入治疗的急性心肌梗死患者随访期预后疗效的影响.方法 214例接受了急诊直接PCI治疗急性心肌梗死患者纳入本研究,根据氯吡格雷用药时间分为两组：氯吡格雷用药时间＜1年组（n=59）和≥1年组（n=155）,收集基线资料包括年龄、性别、心肌梗死部位、梗塞相关血管、冠脉病变血管支数、支架类型、术前Killip分级、出院前左室射血分数（LVEF）、肌酸肌酶（CK）、肌酸肌酶同工酶（CK-MB）、肌钙蛋白I（CTnI）、血红蛋白、冠心病危险因素（吸烟、肥胖、高血压、糖尿病和高血脂）,临床随访平均（41.6±16.3）个月,主要不良心脏事件（MACE）发生28例.结果 两组在性别、心肌梗死部位、血管病变支数、梗死相关血管、Killip分级（Ⅰ级）、阿司匹林使用的比例及吸烟、肥胖、高血压和高血脂所占比例,差异均无统计学意义（P＞0.05）;在氯吡格雷用药时间＜1年组,平均LVEF、血红蛋白水平及药物支架比例显著低于氯吡格雷用药时间≥1年组（P＜0.0001,P＜0.0001,P=0.0065）;在氯吡格雷用药时间＜1年组中,糖尿病的比例和平均年龄高于氯吡格雷用药时间≥1年组（P=0.0190,P＜0.0001）;在氯吡格雷用药时间≥1年组中,平均CK、CK-MB、CTnI高于氯吡格雷用药时间＜1年组（P均＜0.0001）.在氯毗格雷用药时间≥1年组中,随访期间MACE发生率明显低于氯吡格雷用药时间＜1年组（6.45%vs30.51%,P＜0.01）.停用氯吡格雷后,氯吡格雷用药时间≥1年组随访期间MACE发生率明显低于氯吡格雷用药时间＜1年组（2.58% vs 20.34%,P＜0.01）.结论 急诊直接PCI治疗急性心肌梗死是一种有效的方法,氯吡格雷用药时间≥1年以上患者其随访期MACE发生率明显低于氯吡格雷用药时间＜1年者,氯吡格雷用药时间影响其随访期预后.

Objective To evaluate effect of duration of clopidogrel use on clinical follow-up outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Methods A total of 214 patients with acute myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007 were enrolled. All patients were divided into two groups by duration of clopidogrel use; 〈1 year group （n=59） and ≥1 years group （n = 155）. Baseline characteristics [age, gender, angiographic characteristics, Killip classification, LVEF （left ventricular ejection fraction） , CK （creatine kinase）, CK-MB, CTnI （cardiac troponin-I）, hemoglobin levels and history of hypertension, diabetes , hyperlipidemia, obesity and smoking ] of two groups were collected. Clinical follow-up end-point was major adverse cardiac event （MACE） including death, acute myocardial infarction, stent thrombosis and stent restenosis. Clinical follow-up duration was 41.6 ± 16.3 months. MACE occurred in 28 patients. Results Rates of male, infarction site .infarction relative artery, multi-vessel disease, Killip classification （class I） , aspirin use and history of smoking, obesity, hypertension and hyperlipidemia were not different （ P 〉 0. 05） in duration of clopidogrel use 〈 1 year group and ≥ 1 years group. Average LVEF, hemoglobin levels and rate of drug-eluting stents were significantly lower in duration of clopidogrel use 〈 1 year group than that in duration of clopidogrel use ≥1 years group （P 〈0. 0001 ,P 〈0. 0001 ,P=0. 0065）. Average CK、CK-MB.CTnI were significantly higher in duration of clopidogrel use ≥ 1 years group than that in duration of clopidogrel use 〈 1 year group （P 〈 0. 0001 ）. Rate of diabetes and average age were significantly higher in duration of clopidogrel use 〈 1 year group than that in duration of clopidogrel use ≥1 years group （P =0. 0190, P 〈0. 0001 ）. Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use ≥1 years group than that in duration of clopidogrel use 〈 1 year group （6.45% vs 30. 51% ,P 〈0. 01）. After stopping clopidogrel use, incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use ≥1 years group than that in duration of clopidogrel use 〈 1 year group （2. 58% vs 20. 34% , P 〈 0. 01 ） . Conclusion Primary percutaneous coronary intervention is an effective therapeutic method. Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use ≥1 years group than that in duration of clopidogrel use 〈 1 year group. Duration of clopidogrel use may influence clinical outcomes in follow-up period in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.