冠状动脉支架术后阿司匹林和小剂量氯吡格雷双联抗血小板治疗长期随诊

Long-term follow-up of dual antiplatelet therapy with aspirin and low-dose ciopidogrel in patientsundergoing percutaneous coronary intervention

目的探讨冠状动脉支架术（PCI）1年后联合应用阿司匹林和小剂量氯吡格雷抗血小板的有效性和安全性。方法选取2004年3月至2010年9月在我院成功接受药物涂层支架术1年后的冠心病患者3366例，分为联合用药组（服用阿司匹林联合小剂量氯吡格雷，1682例）和阿司匹林组（单纯服用阿司匹林，1684例），随访时间为（29．5±16．3）个月，比较两组主要不良心脑血管事件和临床并发症发生的临床情况。结果心源性死亡联合用药组2例（0．1％），阿司匹林组15例（0．9％），风险比（HR）为0．15（95％CI：0．04～0．68，P〈0．05）；非致死性心肌梗死联合用药组9例（0．5％），阿司匹林组27例（1．6％），HR为0．036（95％CI：0．15～0．74，P〈0．01）；缺血性脑梗死联合用药组7例（0．4％），阿司匹林组27例（1．6％），HR为0．301（95％CI：0．131～0．693，P〈0．01）；再发心绞痛联合用药组152例（9．0％），阿司匹林组274例（16．3％），HR为0．601（95％CI：0．49～0．7，P〈0．01）；心源性死亡患者累积生存率联合用药组优于阿司匹林组（P〈0．01）；主要不良心脑血管事件（MACCEs）累积发生率联合用药组低于阿司匹林组（14．6％比23．2％，P〈0．01）。总死亡数、靶血管再次血运重建、支架内血栓形成、重度出血、轻度出血、白细胞减少及血小板减少两组比较差异均无统计学意义（均P〉0．05）。结论阿司匹林联合小剂量氯吡格雷能降低PCI术患者1年后主要心脑血管事件发生率，不增加出血和血细胞减少的风险。

Objective To assess the efficacy and safety of co-administration of aspirin and low- dose clopidogrel in patients undergoing percutaneous coronary intervention （PCI） after 1 year. Methods From March 2004 to September 2010, a total of 3366 patients with successful drug-eluting stents implantation after 1 year were divided into group A （aspirin combined with low-dose clopidogrel, n= 1682） and group B （aspirin alone, n= 1684）. The average follow-up period was （29.5 ±16.3） months （19 months-76 months）. The major adverse cardiovascular and cerebrovascular events and clinical complications were evaluated. Results Rates of cardiovascular death were 0.1 （2 cases） in combination group and 0.9% （15 cases） in aspirin group, the risk ratio （HR） was 0. 154 %（95% CI： 0. 035-0. 675）, P〈0. 05]. Myocardial infarction occurred in 9 patients （0.5%） in group A and 27 patients （1.6%） in group B, the risk ratio （HR） was 0. 036 [（95% CI： 0. 153-0. 741）, P〈 0. 013. Rates of stroke were 0.4% （7 cases） in group A and 1.6% （27 cases） in group B, the risk ratio （HR） was 0.301 %（95% CI： 0.131-0.693）, P〈 0.013 . Recurrent ischemia with rehospitalization occurred in 152 patients （9.0%） in group A and 274 patients （16.3%） in group B, the risk ratio （HR） was 0. 601 [（95% CI： 0. 491-0. 735）, P〈0. 01]. The cumulative survival rate in patients died of cardiac causes was significantly better in group A than in group B （P〈0.01）. The cumulative incidence of major adverse cardiovascular and cerebrovascular events was significantly lower in group A than in group B （P〈0.01）. There were no significant differences in total number of deaths, target vessel revascularization, stent thrombosis, incidences of severe bleeding, mild bleeding, leukopenia and thrombocytopenia between the two groups （all P〉0.05）. Conclusions In patientswith PCI after 1 year, the co-administration of aspirin and low-dose clopidogrel reduces the risks of major adverse cardiovascular and cerebrovascular events, and does not increase the risks of bleeding and eytopenia.