强化抗血小板干预对老年冠心病患者血小板聚集率及血栓事件的影响

Effects of Strengthening Anti-platelet Intervention on Platelet Aggregation Rates and Thrombotic Events of Elderly Patients with Coronary Heart Disease

目的支架术后双抗血小板治疗1年与2年对老年冠心病患者血小板聚集率及血栓事件的影响。方法选取我院2012年3月至2013年3月300例老年冠心病患者为研究对象,随机分为A组与B组,每组150例。所有患者均随访2年,随访成功率为100%。A组给予支架术后双抗血小板治疗1年,B组给予支架术后双抗血小板治疗2年,其中A组根据植入支架不同分为A_1组(Excel国产支架)与A_2组(XinCEV均衡进口支架),每组75例。其中B组根据植入支架不同分为B_1(Excel国产支架)与B_2组(XinCEV均衡进口支架)。比较A、B组主要心血管(MACE)事件发生率,血小板聚集率及心源性猝死、心梗、靶血管再次PCI及出血事件。比较A1组与B1组MACE事件及A_2组与B_2组MACE事件。结果 A、B组治疗前,随访1、2年后,血小板聚集率比较无统计学意义(P>0.05)。A组MACE事件发生率18.00%高于B组8.67%(P<0.05);A、B组出血发生率比较无统计学意义(P>0.05)。A_1组MACE事件发生率24.00%高于B1组9.33%(P<0.05)。A_2组与B_2组MACE事件发生率比较无统计学意义(P>0.05)。结论支架术后双抗血小板治疗2年与双抗血小板治疗1年比较,发生出血事件没有增多,可进一步有效降低MACE事件发生率,亚组分析中不同支架双抗血小板治疗1年与2年组比较有差异,本研究中进口支架XinCEV双抗血小板治疗1年与2年组比较无差异,提示此组支架抗栓1年治疗时间已经足够,而国产支架Excel需要更长疗程的双抗血小板治疗。

Objective Effects of 1 year and 2 years of dual antiplatelet treatment after stent implantation on platelet aggregation rates and thrombotic events of elderly patients with coronary heart disease. Methods 300 elderly patients with coronary heart disease in our hospital from March 2012 to March 2013 were selected as the research objects, they were divided by random lot method into group A and group B （each 150 cases）. All patients were followed up for 2 years ,and success rate of follow-up was 100%. Group A was given 1 year of dual antiplatelet treatment after stent implantation, group B was given 2 year of dual antiplatelet treatment after stent implantation, Group A was divided into group A1 （ Excel domestic stent） and group A2 （ XinCEV balanced import stent） ,75 cases in each group. Group B was divided into B1 （ Excel domestic stent） and B2 group （XinCEV balanced import stent ） according to different implant frame. Incidence of major cardiovascular（MACE） events, platelet aggregation rate and sudden cardiac death, myocardial infarction ,target vessel change PCT and other bleeding events in group A and B were compared. MACE events in group A1 and B） and MACE events in group A2 and B2 were compared. Results There was no significant difference in platelet aggregation rate after follow-up 1 year and 2 years in group A and B before the treatment（P 〉0. 05 ）. Incidence of MACE events in group A 18.00% was significantly higher than group B （8.67%） （P 〈 0.05 ） ; there was no significant difference in the incidence of bleeding in group A and B （ P 〉 O. 05 ）. Incidence of MACE events in group AI 24. 00% was significantly higher than group B;（9. 33% ） （P 〈0. 05）. There was no significant difference in the incidence of MACE events between group A2 and group B2 （P 〉 0. 05 ）.Conclusion Compared with 1 antiplate]et treatment after stent year of dual antiplatelet treatment after stent implantation, 2 years of dual implantation can effectively reduce incidence of MACE events, there is a difference in 1 year and 2 years of dual antiplatelet treatment after domestic stent, there is no difference 1 year and 2 years of dual antiplatelet treatment after import stent, namely 1 year of dual antiplatelet treatment after import stent is enough,domestic stent need longer course of dual antiplatelet treatment, had good clinical guiding significance.