急性冠脉综合征患者介入治疗早期增加阿司匹林和氯吡格雷剂量对主要不良心血管事件的影响

Effect of increased dosage of aspirin and clopidogrel on major adverse cardiovascular events in early treatment of patients with acute coronary syndrome

目的:观察急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)早期不同剂量阿司匹林、氯吡格雷对主要不良心血管事件(MACE)的影响。方法:选择2007年12月～2009年12月ACS行PCI术的患者102例,所有患者按入院先后随机分为两组,1组为加量组(n=54),患者入院后阿司匹林300 mg顿服,然后300 mg,每日1次,口服1个月后改为100 mg,每日1次,长期口服;氯吡格雷150 mg,每日1次,1周后改为75 mg,每日1次,口服1年。另1组为对照组(n=48),患者入院后阿司匹林100 mg,每日1次,以后长期按此剂量口服。氯吡格雷75 mg,每日1次,口服1年。两组患者其他治疗低分子肝素等方法相同。分别于PCI术后1个月、6个月时比较MACE的发生情况。结果:两组患者临床基线特征基本一致,病变血管分布情况差异无统计学意义。其MACE发生情况在第一个月时,加量组低于对照组,但差异未到达显著水平(7%vs.15%);在第6个月时,加量组低于对照组,差异具有统计学意义(2%vs.17%,P<0.05)。结论:ACS患者在一般治疗的基础上,介入治疗时早期增加阿司匹林、氯吡格雷的剂量可降低PCI术后MACE的发生率。

AIM： To observe the effects of early oral administration of different dosages of aspirin and clopidogrel on major adverse cardiovascular events in acute coronary syndrome（ACS） patients undergoing percutaneous coronary intervention（PCI）.METHODS： From December 2007 to December 2009,102 ACS patients treated with PCI were randomly divided into two groups by admission time sequence.For patients in the treatment group（n=54）,300 mg aspirin was given as a draft after admission and then aspirin was orally administered at 300 mg/day for 1 month.After 1 month,aspirin was orally administered at a dosage of 100 mg/day on a long-term basis.Clopidogrel was orally given at 75 mg/day for 1 year after initial dosage of 150 mg/day for 1 week.For patients in the control group（n=48）,aspirin was orally given at 100 mg/day on a long-term basis and clopidogrel was orally administered at 75 mg/day for 1 year.Supplementary treatments for patients in both groups were given in the same manner.The occurrence of major adverse cardiovascular events（MACE） was compared,respectively,at 1-and 6-months after PCI.RESULTS： Baseline clinical characteristics in the two groups were basically identical and no statistically significant difference was observed for the distribution of vascular lesions.The incidence rate of MACE of treatment group was lower than control group 1 month after PCI,but the difference was not statistically significant（7% vs.15%）.However,6 months later,the difference was statistically significant（2% vs.17%,P0.05）.CONCLUSION： On the basis of general management,increased dosage of aspirin and clopidogrel reduces the occurrence rate of MACE in early treatment of ACS patients undergoing PCI.