氯吡格雷治疗与急性冠脉综合征患者预后相关性研究

Relationship of clopidogrel therapy and outcome of acute coronary syndrome patients

目的探讨氯吡格雷治疗与急性冠状动脉综合征(acute coro nary syndrome,ACS)患者主要心血管不良事件增加与早期支架内血栓形成相关性。方法纳入1286例ACS患者,将患者分为氯吡格雷入院前长期治疗组(氯吡格雷组,n=162)与未接受氯吡格雷治疗组(非氯吡格雷组,n=1124)。比较2组患者住院期间及出院后30d主要不良心血管事件发生率,包括死亡、ACS复发、脑卒中发病、支架内血栓形成等。采用Logistic回归分析患者主要心血管不良事件发生的相关因素。结果氯吡格雷组合并症发生率、心脑血管病史与既往血运重建治疗史患者比例显著高于非氯吡格雷组(均P<0.001);氯吡格雷组患者住院期间支架内血栓形成、急性肾衰竭和充血性心力衰竭发病率显著高于非氯吡格雷组(均P<0.05)。出院30d氯吡格雷组患者支架内血栓形成发病率、ACS复发率均显著高于非氯吡格雷组(均P<0.05),多元Logistic回归分析表明长期氯吡格雷治疗是患者发生主要不良心血管事件的独立危险因素(OR=1.36,95%CI:1.03-1.83,P=0.045),也是出院30 d支架内血栓形成的独立危险因素(OR=2.71,95%CI:1.39-5.76,P=0.02)。结论氯吡格雷治疗是ACS患者主要心血管不良事件,是支架内血栓形成的高危因素。

Objective To explore the relationship of clopidogrel therapy and increased adverse events,early stent thrombosis. Methods 1286 ACS patients were divided into clopidogrel long-term treatment group before admission（ clopidogrel group,n = 162） and without clopidogrel treatment group（ non-clopidogrel group,n = 1124）. Compared the occurrence of major adverse cardiovascular events between two groups of patients during hospitalization and discharged 30 days,including death,recurrent ACS,stroke,stent thrombosis,etc. Logistic regression was used to analyse the factors associated with major adverse cardiovascular events. Results The incidence rate of complications,cerebrovascular disease and previous revascularization of clopidogrel group was significantly higher than that in non-clopidogrel group（ all P〈0. 001）. The incidence rate of early stent thrombosis,acute renal failure and congestive heart failure in clopidogrel group during hospitalization was significantly higher than that in non-clopidogrel group（ all P〈0. 05）.The incidence rate of early stent thrombosis,recurrence rate of ACS and acute renal failure and congestive heart failure in clopidogrel group during hospitalization was significantly higher than that in non clopidogrel group（ all P〈0. 05）. Multivariate logistic regression analysis showed that long-term clopidogrel therapy was independent risk factors in patients with major adverse cardiovascular events（ OR = 1. 36 95%,CI： 1. 03-1. 83,P = 0. 045） and the independent risk factors of thrombosis in stent（ OR = 2. 71,95% CI： 1. 39-5. 76,P = 0. 02）. Conclusion Patients sustaining ACS while on clopidogrel treatment are at higher risk for in-hospital and 30-day adverse outcomes,including stent thrombosis.