支架内完全慢性闭塞患者经皮冠状动脉介入后延长双联抗血小板治疗的疗效和安全性评估

Efficacy and Safety of Prolonged Dual Antiplatelet Therapy after Percutaneous Coronary Intervention in In-Stent Chronic Total Occlusion

目的比较支架内慢性完全闭塞(ISTCO)患者经皮冠状动脉介入(PCI)后延长双联抗血小板治疗(DAPT)的疗效和安全性。方法本研究纳入2015年1月至2018年12月315例接受PCI治疗的ISCTO患者,其中接受12个月DAPT治疗组(标准疗程组)241例,接受≥18个月DAPT治疗组(长疗程组)74例。评估主要心血管事件发生率和出血事件发生率。结果标准疗程组中位时间12个月,长疗程组中位时间31个月。与标准疗程组相比,长疗程DAPT治疗能降低复发心绞痛(44%vs 33.8%,P=0.026)、靶血管再狭窄或闭塞(32%vs 15.4%,P=0.012)、靶血管血运重建(31.1%vs 13.5%,P=0.01)等事件发生率;但靶血管相关的心肌梗死、心力衰竭、心源性猝死、全因死亡等事件发生率比较差异无统计学意义。仅标准组有1例患者在PCI术后5个月发生消化道出血。结论对于接受PCI治疗的ISCTO患者延长双联抗血小板治疗安全有效。

Objective To explore the efficacy and safety of prolonged dual antiplatelet therapy(DAPT)after percutaneous coronary intervention(PCI)in in-stent chronic total occlusion(ISCTO).Methods A total of 315 ISCTO patients who successfully underwent PCI in our hospital from January 2015 to December 2018 were enrolled in this study.DAPT was applied in 241 patients for 12 months(standard group)and in 74 patients for 18 and over 18 months(prolonged group).The incidences of major adverse cardiovascular events(MACEs)and bleeding events after PCI were evaluated.Results The rates of recurrent angina pectoris(44%vs 33.8%,P=0.026),target-vessel restenosis(32%vs 15.4%,P=0.012)and target-vessel revascularization(31.1%vs 13.5%,P=0.01)in the prolonged group were significantly higher than those in the standard group.But there were no significant differences in the events of heart failure(7.1%vs 4.1%,P=0.196),target-vessel myocardial infarction(2.1%vs 0%,P=0.178)or cardiac mortality(0.8%vs 0%,P=0.375)between two groups.Gastrointestinal hemorrhage occurred in one patient at 5 months after PCI in standard group.Conclusion For ISCTO patients after PCI,DAPT should be used at least 18 months,which will reduce the occurrence rates of MACEs and will not increase bleeding risk.