不同抗血小板治疗策略对非透析慢性肾功能不全患者冠状动脉搭桥术后胸廓内动脉及大隐静脉桥血管通畅率的影响

Different DAPT effects on patency of internal thoracic artery and great saphenous vein grafts after CABG in patients with non-dialysis CKD

目的比较阿司匹林联合替格瑞洛或者氯吡格雷的双联抗血小板药物治疗(DAPT),对慢性肾功能不全患者冠脉搭桥手术(CABG)术后早期桥血管通畅率的影响。方法我科接受CABG手术患者77例,随机纳入A组(阿司匹林+替格瑞洛)与B组(阿司匹林+氯吡格雷)。A组35例,B组42例。术后1年行计算机断层扫描血管造影(CTA)检查,评估桥血管通畅性。并随访主要心血管事件、出血事件发生情况。结果随访期间7例失访。70例完成CTA检查,A组32例,B组38例。静脉桥血管通畅率A组显著高于B组(46/5190.2%vs 42/5675.0%,P=0.024)。小型出血事件发生率A组高于B组(P=0.022)。Logistic回归分析提示替格瑞洛+阿司匹林双联抗血小板治疗可以降低桥血管狭窄风险(OR=0.193,95%CI=0.043-0.861,P=0.031)。结论在CKD患者接受冠状动脉搭桥术后,DAPT替格瑞洛联合阿司匹林可能更好地维护静脉桥血管的通畅率,并未增加主要出血事件的风险。

Objective To compare the effects of dual antiplatelet therapy(DAPT)of aspirin combined with ticagreloror clopidogrel on graft patency one year after coronary artery bypass graft surgery(CABG)in patients with chronic kidney disease(CKD).Methods A total of 77 CABG patients in our department were included in the study.They were randomly divided into groupA(aspirin+ticagrelor)and group B(aspirin+clopidogrel).There were 35 participants in group A and 42 in group B.Computed tomography angiography(CTA)was performed on them one year after the operation to evaluate the graft patency.Cardiovascular events,bleeding events and other adverse events were also followed up.Results Totally seven patients were withdrawn in the follow-up,and 70 patients received CTA.Among them,32 cases in group A and 38 cases in group B.The patency rate of vein bridge in group A was significantly higher than that in group B(46/5190.2%vs 42/5675.0%,P=0.024).And the incidence rate of minor bleeding events in group A was higher than that in group B(P=0.022).Logistic regression analysis revealed that DAPT of aspirin combined with ticagrelor can reduce the risk of vein bridge stenosis(OR=0.193,95%CI=0.043-0.861,P=0.031).Conclusion DAPT of aspirin combined with ticagrelor after CABG can better maintain the graft patency of CKD patients without additional risk of major bleeding events.